Gastroenterology - Bravo pH Study (Wireless Capsule pH Study)

This leaflet has 3 aims:

1. To help you become better informed and more involved in your care.
2. To explain what happens on the day of the procedure.
3. To answer some of the questions commonly asked about the procedure.

If you have any questions, access or communication needs such as an interpreter please contact the department stated on your appointment letter.

Reasonable adjustments will be considered for all disabled users of this service.

Please make sure that you read all the following information CAREFULLY, which includes what you must do prior to coming for your appointment.

Your healthcare professional has referred you for a wireless capsule pH study (non-tube pH study) because you are experiencing problems with your gullet (oesophagus). You will have attempted a standard tube based 24hr study previously which was not successful. The most common complaints for referral for this test are acid reflux/heartburn.

When you come for your appointment, it would be helpful to us if you could bring a list of your medications with you.
 
If you have any heart or breathing problems/conditions, we would appreciate it if you could notify us of these conditions before you attend for your appointment.

What is a wireless capsule pH study?

This is a test that requires the placement of a small capsule on to the lining of your gullet. This is done via an endoscopy (camera test). The capsule contains a battery and acid sensor. During the study, which can last up to 96 hours, you will carry a recorder around with you (this must be on you or at very close range at all times) which collects the data. After a few days, the capsule will naturally detach from your gullet, and you will pass this safely through your gut and pass it out at the other end (when you have a bowel action). The pH study shows us how much time acid is in the gullet for.

What will happen during the test?

You will first see a trained member of the GI Physiology team where you will discuss your symptoms. After we have asked you questions about your symptoms and obtained your written consent for wireless capsule pH study you will be seen by endoscopy staff. The endoscopy part will be explained to you, but a brief description is below. Trained staff will obtain written consent for this part of the procedure also.

The endoscopy will always be carried out by an experienced endoscopist or trainee endoscopist under appropriate supervision. In the examination room you will be made comfortable on a couch, resting on your left side. A nurse will stay with you throughout the test. Some endoscopists may spray a local anaesthetic on to the back of the throat. The endoscopist may give you an injection in your arm to make you feel sleepy and relaxed, but many hospitals now find the test can be performed without any sedation as the endoscopes are much smaller and easier to swallow. To keep your mouth open, a plastic mouthpiece will be put gently between your teeth. When the endoscopist passes the endoscope into your stomach/gullet it will not cause you any pain, however it can be uncomfortable. It will not interfere with your breathing at any time. If you get a lot of saliva in your mouth, the nurse will clear it using a sucker (similar to what is used at the dentist).

In order to place the capsule in the correct position the scope will be passed into your gullet to check the capsule position. The scope will then be removed, and the capsule will be introduced into the gullet, via the mouth, and when at the correct position suction is applied to attach the capsule to the lining of the gullet. The scope is then reintroduced to check that the capsule is in place. Once the procedure is finished the physiologist will go through the diary sheet that you need to complete for us. If you are having sedation this will be done prior to the test.

Sedation

Sedation is optional, and if you would like sedation, you must have someone to pick you up and who can stay with you. If you do not you will not be able to have sedation.

After the test

If you do not have sedation, you will be able to go home once the diary sheet has been explained to you and a return appointment has been made you are free to go. If you have had sedation, you will be left to rest in the recovery ward for at least an hour before being allowed to go home.

If you have had sedation, it is essential that someone comes to the unit to pick you up after the test and is able to stay with you. Once home, it is important to rest quietly for the remainder of the day.

You will be given a drink but if you have had your throat numbed by a spray, you will have to wait until your swallowing reflex is back to normal. After this you can eat and drink normally.

The back of your throat may feel sore for the rest of the day. Once you leave the department you will carry on with your normal activities, and you will be told where to return the equipment (recorder and diary) to at a pre-arranged date and time.

Is the test painful?

Some people are aware of the capsule being there until it detaches from the gullet, and for some of these people it can be uncomfortable and possibly painful. It is advised that regular pain medication such as paracetamol or ibuprofen is taken to ease any pain or discomfort. However, the majority of people are unaware of the capsule being there. With the endoscopy, people do find this uncomfortable, but this is temporary i.e. during the procedure only. Sedation is available (see above) if this is something that you may want to have.

How long will the test take?

The procedure itself is around 20 minutes. However you could be with us for around an hour, but this could vary. The recording itself can be up to 96 hours depending on what your referring doctor or surgeon would like to know.

Reasonable adjustments will be considered for all disabled users of this service.

What do I need to do before the test?

You will need to fast for a minimum of 6 hours prior to the study. The majority of studies are done whilst not taking medication for your stomach. Your appointment letter will state whether you are to stop certain medications or not so please read your appointment letter very carefully. If you are told to stop certain medications, please see the list below.

7 days prior to the test: Omeprazole (Losec, Pyrocalm, Mezzopram); Esomeprazole (Nexium, Emozul, Guardium, Ventra); Lansoprazole (Zoton, Prevacid); Pantoprazole (Protium, Pantoloc); Rabeprazole (Pariet)

3 days prior to the test: Cimetidine (Tagamet); Nizatidine (Axid); Famotidine (Pepcid); Domperidone (Motilium); Metoclopramide (Maxolon); Ondansetron; Alverine; Baclofen (Lioresal), Mebeverine (Colofac); Peppermint Oil (Colpermin, Mintec,), Merbentyl (diclomine, Bentyl), Hyoscine (Buscapan), Pro- Banthine, Spasmanol, Colesevalam, Prucalopride

24hrs before the test: Altacite; Gaviscon; Gaviscon Advance, Maalox; Mucogel, Alu-cap, Co-magaldrox, Asilone; Mucaine; Rennies; Settlers; Algicon Bisodol, Acidex, Peptac, Gastrocote, Pepto-Bismol

Please continue with all other medications.

Will I be able to ask questions?

You can ask questions at any time prior to, during the test, and after the tests.

When will I get the results?

The results of your test will be sent to your hospital consultant or nurse specialist, and you should hear from them within a few weeks.

Benefits and Risks

The benefit of having this test is that it will help your Health Care Professional determine the problem with your gullet. It can help them manage your symptoms and, in some cases, decide which medication to give you. It will also help them to decide on your future management.

If you have oesophageal varices (prominent veins in your gullet) we would not go ahead with this test.

There are some risks associated with a non-tube pH study. These include discomfort associated with the attachment of the pH capsule; tears in the mucosa (lining of the gullet); capsule detaching early; capsule retention; and bleeding.

There are certain risks associated with the endoscopy. This includes perforation (a tear) of the oesophagus and bleeding. These are quite rare (1:1000).
 
Some people experience discomfort due to them stopping their stomach medication, this is quite normal.

The alternative test is a tube-based study; however, it is likely that you will have tried this unsuccessfully already. Occasionally a barium swallow is performed as an alternative, but this test does not give the same accuracy as either a tube or non-tube pH study.

Smoking Policy

Northern Care Alliance operates a smoke free policy. To find out what this means for you, pick up the leaflets available at the hospital. For advice on stopping smoking contact 0161 212 4050.