A new patient-friendly test for gastric reflux reduces the discomfort, and often embarrassment, of traditional methods used to diagnose patients with chronic heartburn.
With heartburn, patients experience a burning feeling in the center of the chest, or a bitter or sour taste in their mouths. Usually it lasts for hours and is often worse after eating. Heartburn that occurs more than twice a week may be related to a more serious problem known as gastroesophageal reflux disease, or GERD. Left untreated, GERD can lead to difficulty in swallowing or worse, damage to the esophagus.
Diagnosing chronic heartburn requires measuring the acid levels in the esophagus caused by the stomach acid reflux.
“Normally a patient would come in and we would have to place a tube in his nose, down the back of his throat and into his esophagus. The tube is connected to a monitor the patient would have to wear for 24 hours,” explained Celine Vollmer, Endoscopy nurse manager at Baptist Hospital East.
Patients are asked to maintain their normal schedule for the 24 hours to get an accurate pH (acid) level and keep a diary of their activities. However, many patients are reluctant to go out in public with the monitoring device attached and a tube sticking out of their nose. The tube can also cause a gagging sensation.
“Patients would either go home and do nothing for 24 hours or pull the tube out. It was difficult to get a true measurement of their 24-hour pH level or diagnose GERD,” she said.
The Bravo pH Monitoring System, now available for patients, is tubeless, eliminating the discomfort and embarrassment. A small capsule, approximately the size of a vitamin, is attached to a patient’s esophagus during an endoscopy. The capsule measures the pH levels in the esophagus and transmits the information to a pager-sized receiver that can be worn on the waistband. The information can be uploaded into a computer and provide data to a physician to either make a diagnosis, or ascertain whether the patient’s current medication dosage is correct.
The wireless receiver can record readings as far away as nine feet, providing more convenience for patients.
“Sleeping, taking a shower and other things you would do in a normal day are very difficult with the tube system. This is so much more comfortable for patients. They can go out and do anything they would normally do,” Vollmer said.
Data can be collected for up to 48 hours. After the test, patients return the receiver and a diary they keep during the test period. Several days after the test period, the capsule naturally falls off the wall of the esophagus, passes through the digestive tract, and is eliminated from the body.
“A lot of physicians have patients who need to have this study done, but the patients have been a little reluctant in the past because of the catheter involved. Now more patients will want to have the study done, and we’ll be able to get a more accurate reading of their 48-hour esophageal pH. We’re very excited to be one of the first hospitals to offer this new test to our patients,” she said.
Gastroenterologist Martin Mark, M.D., said the true beauty of the Bravo system – besides greater patient comfort – is its ability to help sort out whether the patient has GERD or another ailment. “When you use the Bravo system, think of it as a question that you want answered,” Dr. Mark said. “The question invariably is ‘does the patient truly have reflux’ and it’s not obvious to the investigator.”
Obvious cases of heartburn can be immediately treated with medication. The Bravo system comes in handy when symptoms aren’t so obvious, or could be confused with other conditions. Examples include chest pain, chronic coughing, asthma and sore throat – all of which can be symptoms of GERD. “One-third of patients with chest pain do not have heart disease,” Mark said. After a cardiologist rules out heart disease as a cause of the chest pain, the patient may be sent to a gastroenterologist for follow-up.
“Up to 80 percent of asthmatics have GERD,” Dr. Mark said. “Cough is a potential manifestation of reflux as well. Not all reflux is obvious.”
GERD affects an estimated 5 to 7 percent of the world’s population – men, women and children – based on cases where the person has daily heartburn. Heartburn or acid regurgitation weekly occurs in almost 20 percent of individuals.
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