Tolerability of Ambulatory Esophageal pH Monitoring Using Nasally Placed pH Catheter vs. BRAVO pH Capsule

Abstract

Purpose: In this study, we aimed to compare the tolerability of ambulatory esophageal pH monitoring using a nasally placed pH catheter versus endoscopically placed Bravo pH capsule. Methods: The records of 103 patients >18 years of age undergoing traditional catheter-based intranasal pH monitoring (Sandhill, pH/impedance catheter) or Bravo pH capsule monitoring over a 3-year period were reviewed. Information obtained included the patient's gender, age, race and indication for study. Tolerance was determined by a questionnaire the patient completed after pH monitoring assessing the patient's comfort, difficulty speaking, percentage of usual food intake, and percent of usual activity. Statistical analysis was performed on categorical data using the Fisher's exact test, and on continuous data with the independent t-test. Results: Of the 103 records reviewed, traditional catheter-based intranasal pH monitoring was performed in 53 patients (53% male, 68% Caucasian, 21% African American, 11% other ethnicities), while Bravo pH testing was performed in 51 patients (53% male, 70% Caucasian, 26% African American, 4% other ethnicities). The mean age of those undergoing catheter-based intranasal pH monitoring was 43 ± 12 years vs. 44 ± 14 years for those undergoing Bravo pH monitoring (P= 0.871). In the traditional catheter-based intranasal pH monitoring 50% reported that they were comfortable or slightly uncomfortable. Compared to 86.6% of those undergoing Bravo pH monitoring (P < 0.0001). Significantly more patients undergoing the catheter based pH monitoring reported difficulty speaking compared to patients undergoing the Bravo pH monitoring (52.8% vs. 8.1%, P < 0.0001). Difficulty eating was reported more frequently in patients with the catheter-based intranasal pH monitoring compared to those undergoing Bravo pH monitoring (94.3 vs. 65%P < 0.0001). The percent of usual food intake was similar in both groups of patients (catheter-based intranasal pH monitoring group 81 ± 3.4% vs. 82 ± 2.9% in the Bravo pH monitoring group P= 0.946). The percent of usual activity in the catheter-based intranasal pH monitoring group was significantly less compared to the Bravo pH monitoring group (68 ± 2.6% vs. 86 ± 3.1%P < 0.0001). Finally the percent of usual symptoms was significantly less in the catheter-based intranasal pH monitoring group compared to the Bravo pH monitoring group (53% ± 5% vs. 78 ± 4.6%P < 0.0001). Conclusion: Our study indicates that the Bravo pH capsule is safe and better tolerated than traditional catheter-based intranasal pH monitoring however, the Bravo is unable to measure non-acid reflux.