Mehmet Gok, Genco Gencdal


Background and aim: Gastroesophageal reflux disease (GERD) is a common disease in the world. GERD is always treated with drugs. The Bravo® wireless pH monitoring system is a good technique. The Bravo® may affect increasing the specificity and sensitivity in the diagnosis of GERD with its 48-hour recording feature.  In this study, we aimed to assess the diagnostic performance of the Bravo® pH monitoring system in patients with non-erosive GERD.

Materials and Methods: Patients with non-erosive reflux disease (normal endoscopy) whose symptoms persisted after PPI treatment (at least two months) were included in the study. All patients had upper gastrointestinal system endoscopies performed in our clinic between January 2013 and December 2019. All patients had a 48-hour Bravo® wireless pH monitoring record.

Results: Twenty-three patients (M: 18 (78.3%; Age:35.7±11) were included in the study. All patients completed the 2-day recording protocol. During and after the procedure, no patient showed any adverse effects of the Bravo® procedure. We diagnosed GERD in 13 of 23 patients by Bravo® capsule. According to the Bravo® pH-meter recordings; Total time pH<4 (minute) was 187±190, the total number of refluxes was 90±61, the percentage of time with pH<4 was 7.1±7.22, the number of long reflux events were 8.1±8, the duration of the longest reflux episode during pH<4 (minute) was 31±49, the Demeester score was 20.8±19.3 detected.

Conclusion: Based on the results of the current study, the Bravo® pH monitoring system is a practical and effective diagnostic technique for non-erosive GERD. Further prospective studies would be useful for comparing the differences between 24-hour and 48-hour pH recording results.


Gastroesophageal Reflux, esophagus, reflux

Full Text:



Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006; 101(8):1900-20. doi: 10.1111/j.1572-0241.2006.00630.x.

Kahrilas PJ, Shaheen NJ, Vaezi MF, Hiltz SW, Black E, Modlin IM, et al. American Gastroenterological Association medical position statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135(4):1383-91. doi: 10.1053/j.gastro.2008.08.045.

Bor S, Vardar R, Vardar E, Takamz S, Mungan ZA. Endoscopic findings of gastroesophageal reflux disease in Turkey: Multicenter prospective study (Gorhen). Gastroenterology. 2008;4(134):A -600. Doi: 10.1016/S0016-5085(08)62804-8

Martinez SD, Malagon I, Garewal HS, Fass R. Non-erosive reflux disease (NERD) - is it really just a mild form of gastroesophageal reflux disease (GERD) Gastroenterology. 2001;5(suppl 1): A424. 10.1016/S0016-5085(01)82102-8

Sifrim D, Zerbib F. Diagnosis and management of patients with reflux symptoms refractory to proton pump inhibitors. Gut. 2012; 61(9):1340-54. Doi: 10.1136/gutjnl-2011-301897.

Kahrilas PJ, Quigley EM. Clinical esophageal pH recording: a technical review for practice guideline development. Gastroenterology. 1996;110(6):1982–96. doi: 10.1053/gast.1996.1101982.

Numans ME, Lau J, de Wit NJ, Bonis PA. Short-term treatment with proton-pump inhibitors as a test for gastroesophageal reflux disease: a meta-analysis of diagnostic test characteristics. Ann Intern Med. 2004 ;140(7):518-27. doi: 10.7326/0003-4819-140-7-200404060-00011.

Vardar R, Keskin M. Indications of 24-h esophageal pH monitoring, capsule pH monitoring, combined pH monitoring with multichannel impedance, esophageal manometry, radiology and scintigraphy in gastroesophageal reflux disease. Turk J Gastroenterol. 2017; 28(Suppl 1): S16-S21. doi: 10.5152/tjg.2017.06.

Azzam RS, Sallum RA, Brandao JF, Navarro-Rodriguez T, Nasi A. Comparative study of two modes of gastroesophageal reflux measuring: conventional esophageal pH monitoring and wireless pH monitoring. Arq Gastroenterol. 2012; 49(2): 107-12. doi: 10.1590/s0004-28032012000200003.

Hakanson BS, Berggren P, Granqvist S, Ljungqvist O, Thorell A. Comparison of wireless 48-h (Bravo) versus traditional ambulatory 24-h esophageal pH monitoring. Scand J Gastroenterol. 2009;44(3): 276-83. doi: 10.1080/00365520802588109.

Pandolfino JE, Richter JE, Ours T, Guardino JM, Chapman J, Kahrilas PJ. Ambulatory esophageal pH monitoring using a wireless system. Am J Gastroenterol. 2003; 98(4):740–9. doi: 10.1111/j.1572-0241.2003.07398.x.

Ward BW, Wu WC, Richter JE, Lui KW, Castell DO. Ambulatory 24-hour esophageal pH monitoring. Technology searching for a clinical application. J Clin Gastroenterol. 1986;8(suppl 1):59–67. doi: 10.1097/00004836-198606001-00009.

Kwiatek MA, Pandolfino JE. The Bravo pH capsule system. Dig Liver Dis. 2008;40(3): 156-60. doi: 10.1016/j.dld.2007.10.025

Ono S, Kato M, Ono P, Asaka M. New method for long-term monitoring of intragastric pH. World J Gastroenterol. 2007;13(47) 6410-3. doi: 10.3748/wjg.v13.i47.6410.

Grigolon A, Bravi I, Cantu P, Conte D, Penagini, R. Wireless pH monitoring: better tolerability and lower impact on daily habits. Dig Liver Dis. 2007;39(8):720-4. doi: 10.1016/j.dld.2007.05.011

Wood RK. Endoscopic aspects in diagnosis of gastroesophageal reflux disease and motility disorders: Bravo, capsule, and a functional lumen imaging probe. Tech in Gastrointest Endosc.2014;16(1):2-9.doi: 10.1016/j.tgie.2013.11.001

Iluyomade A, Olowoyeye A, Fadahunsi O, Thomas L, Libend CN, Ragunathan K, et al. Interference with daily activities and major adverse events during esophageal pH monitoring with bravo wireless capsule versus conventional intranasal catheter: a systematic review of randomized controlled trials. Dis Esophagus. 2017;30(3):1-9. doi: 10.1111/dote.12464.

Lawenko RM, Lee YY. Evaluation of gastroesophageal reflux disease using the Bravo capsule pH system. J Neurogastroenterol Motil. 2016;22(1):25-30. doi: 10.5056/jnm15151.

Bechtold ML, Holly J S, Thaler K, Marshall J B. Bravo (wireless) ambulatory esophageal pH monitoring: how do day 1 and day 2 results compare? World J Gastroenterol. 2007; 13(30): 4091–5. doi: 10.3748/wjg.v13.i30.4091.

Chander B, Hanley-Williams N, Deng Y, Sheth A. 24 versus 48-hour Bravo pH monitoring. J Clin Gastroenterol. 2012; 46(3): 197–200. doi: 10.1097/MCG.0b013e31822f3c4f.

Remes-Troche JM, Ibarra-Palomino J, Carmona-S´anchez RI, Valdovinos MA. Performance, tolerability, and symptoms related to prolonged pH monitoring using the Bravo system in Mexico. Am J Gastroenterol. 2005; 100(11): 2382–6. doi: 10.1111/j.1572-0241.2005.00292.x.

Domingues GR, Moraes-Filho JP, Domingues AG. Impact of prolonged 48-h wireless capsule esophageal pH monitoring on the diagnosis of gastroesophageal reflux disease and evaluation of the relationship between symptom and reflux episodes. Arq Gastroenterol. 2011; 48(1):24–9. doi: 10.1590/s0004-28032011000100006.

Chotiprashidi P, Liu J, Carpenter S, Chuttani R, DiSario J, Hussain N, et al. ASGE Technology Status Evaluation Report: wireless esophageal pH monitoring system. Gastrointest Endosc. 2005;62(4):485-7. doi: 10.1016/j.gie.2005.07.007.

De Hoyos A, Esparza EA. Technical problems produced by the Bravo pH test in non-erosive reflux disease patients. World J Gastroenterol. 2010;16(25):3183-6. doi: 10.3748/wjg.v16.i25.3183.



  • There are currently no refbacks.

Copyright (c) 2022 Genco Gencdal

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.