Overview
Objective proof of reflux — or proof you do not have it.
The Bravo pH study measures how often acid from the stomach refluxes into the esophagus over 48 to 96 hours. A small capsule — about the size of a vitamin pill — is attached to the esophageal lining during a brief upper endoscopy. The capsule transmits pH readings wirelessly to a small recorder you wear on your belt. After the study period, you return the recorder and the capsule detaches on its own within a few days, passing harmlessly through the digestive tract.
We order Bravo studies most often as part of the workup before anti-reflux surgery — Nissen fundoplication, Toupet fundoplication, hiatal hernia repair, or LINX. Anti-reflux surgery works extraordinarily well when reflux is objectively confirmed, but symptoms alone are an unreliable guide — many patients with "heartburn" have something else going on, and many patients with non-classic symptoms (cough, hoarseness, chest pain) genuinely have reflux. The Bravo gives us the data we need to recommend surgery confidently — or to recommend against it when reflux turns out not to be the cause.
Who is a candidate?
Patients being evaluated for anti-reflux surgery are the most common candidates — we run Bravo on most patients before recommending Nissen, Toupet, or LINX. Patients with typical heartburn that does not respond fully to PPIs, patients with atypical symptoms like chronic cough or hoarseness, and patients with failed prior fundoplication who need reassessment are also candidates. Bravo placement requires endoscopy under sedation, so patients who cannot safely undergo endoscopy are not candidates and we use a thin transnasal pH catheter instead.
How we perform it
The procedure takes about 20 minutes. You arrive fasting, receive sedation, and we perform a routine upper endoscopy. After examining the esophagus, stomach, and duodenum, we measure 6 cm above the gastroesophageal junction and deploy the capsule under direct vision using a delivery system that briefly applies suction and fires a small clip. The capsule is secured to the esophageal wall. You wake up, are given the wearable recorder, and go home the same day. You record symptoms, meals, and sleep in a diary or via the recorder buttons over the next 2–4 days.
Results and follow-up
You return the recorder at 48 or 96 hours depending on the protocol. We download the data and review the report — percent time pH is below 4, number and timing of reflux events, and symptom correlation. Results are usually ready in a few business days. We see you in clinic within 1–2 weeks to review the report and discuss the next step: anti-reflux surgery if reflux is confirmed, medication optimization if it is borderline, or further workup if reflux is excluded and another cause needs to be pursued.
Why Florida Surgical
Bravo is most useful when the surgeon who interprets the results is the surgeon who would do the anti-reflux operation. We do both. That continuity means the diagnostic study, the operative planning, and the post-op care are all coordinated — and we never operate on suspected reflux without the data to back it up. Both Dr. Shaw and Dr. Decio perform Bravo studies and the anti-reflux operations that follow.
Frequently asked questions
Why do I need a Bravo study before reflux surgery?
Anti-reflux surgery (Nissen, Toupet, hiatal hernia repair, LINX) works best when objective testing confirms abnormal acid exposure in the esophagus. The Bravo gives 48–96 hours of pH data — much more reliable than symptoms alone. Confirming reflux objectively before surgery improves outcomes and reduces the risk of operating on someone whose symptoms turn out not to be from reflux.
How is the capsule placed?
During a routine upper endoscopy (EGD). After we look at the esophagus, stomach, and duodenum, we measure 6 cm above the gastroesophageal junction and attach the capsule with a small clip. It takes a few seconds and you do not feel it afterward.
Will I feel the capsule?
Most patients do not feel it. A minority report a brief sensation of fullness in the chest with swallowing in the first day or two. The capsule detaches on its own within about a week and passes naturally through the digestive system.
Should I be on or off my acid medication?
It depends on the question. For diagnosis of GERD (most common before fundoplication), we run the test off medication — typically PPIs stopped for 7 days, H2 blockers for 3 days. For patients with persistent symptoms on therapy, we sometimes run on-medication to see if reflux is breaking through. We tell you which one before the EGD.
What do the results mean?
The main number is the percent of time the esophagus is acidic (pH below 4). More than 6% over 24 hours is abnormal and supports GERD. We also look at symptom correlation — episodes of heartburn matched in time with acid events. We review the full report with you and decide together on next steps.