BRAVO pH Monitoring

This information was reviewed and approved by Eric Yager, MHA, RT(R)(CT)(BD), Seth Zucker, BSN, MA, CAPA (12/31/2022).

What is a BRAVO pH monitoring study?

Your doctor has suggested you have a BRAVO pH monitoring study as part of the evaluation at National Jewish Health. This study assesses the amount of acidic gastroesophageal reflux you have. Gastroesophageal reflux is the flow of food and/or fluid from the stomach into the esophagus. The esophagus is the tube connecting your mouth to your stomach. A BRAVO pH monitoring study will help identify whether you have acid reflux and whether this reflux is associated with any of your symptoms.

Preparing for a BRAVO pH monitoring study

The BRAVO will be placed during your EGD, and you will go home with an external receiver (see below). In addition to the EGD instructions, please follow these instructions closely.
Notify your doctor if you have an implanted monitoring device, like a pacemaker.
Notify your doctor if you take blood thinners such as Coumadin, Plavix, Lovenox, Pradaxa, etc., as you might need to hold these medications a day or so before your procedure.
Notify your doctor if you take any oral medicines or insulin for diabetes.
Notify your doctor if you take any injectable (shots) medications for weight loss/diabetes such as Ozempic, Mounjaro, Wegovy, Trulicity, etc., as you may need to hold these medications up to a week before your procedure.
Do Not take your reflux/antacid medicines, unless advised otherwise by your doctor.
- Stop these medicines at least 3 days before your appointment: Tagamet® (Cimetidine), Axid® (Nizatidine), Pepcid® (Famotidine), Reglan® (Metoclopramide).
- Stop these medicines at least 7 days before your appointment: Prilosec® (omeprazole), Prevacid® (lansoprazole), Nexium® (esomeprazole), Protonix®, Pantoloc® (pantoprazole), Aciphex (rabeprazole), Dexilant (dexlansoprazole).
- Continue to take all your other medicine as you usually do.
Stop eating food 8 hours before your procedure. You may still sip clear liquids (only) until 4 hours before your procedure. Stop drinking fluids of any kind 4 hours before your procedure. If you do not follow these instructions, your procedure will be delayed or cancelled.

On Procedure Day

A responsible adult must wait for you at National Jewish Health during your procedure, and take you back to your residence after you are discharged. You will not be able to drive yourself or take a taxi/public transportation. If you do not have someone with you to drive you home, your procedure will be cancelled.
Check in at the Front Desk. If you have questions and/or need to reschedule/cancel your appointment, please call 303-398-1355.
You should not work, drive, or make any important decisions for the rest of the day.
We suggest that someone stay with you overnight.

What is Done during the test?

While you are being prepped for your procedure, you will watch a video describing what you will need to do once you leave with the BRAVO. During your EGD, the doctor will attach the BRAVO capsule to the inside lining of your esophagus, near the stomach. This capsule is about an inch long and roughly as wide as a pencil. It measures pH (acid) levels in the esophagus, and will send this pH information to a BRAVO receiver. The receiver is about the size of a cell phone and should keep within 3 feet of you at all times, even when you shower (just don’t let it get wet). The BRAVO study lasts for 96 hours (4 days). During this time, you will keep a diary to track when you eat/drink, when you sleep, and when you have any symptoms that might relate to the reflux. Try to maintain all regular activities as much as possible during the study. A nurse will let you know the best time and place to return the BRAVO receiver and diary. The BRAVO capsule will fall off your esophagus within 5 to 7 days after placement, and you will pass it through your digestive tract.

The URL for this video is: https://www.youtube.com/watch?v=1p-_WsNwiW4

Special Instructions

Do Not have any barium X-ray tests done until the BRAVO pH monitoring study is complete.
Do Not have an MRI unless you are sure you have passed the BRAVO capsule from your body. If you are unsure this has occurred, wait 30 days after the BRAVO placement before having an MRI or obtain a Chest X-ray prior the MRI.