Bravo Capsule test

What is the Bravo capsule test? How does it work?

The Bravo capsule is a wireless device that can diagnose or confirm gastroesophageal reflux or “acid reflux” in children 4 years of age and older. It consists of a small capsule and a recorder.

Your child’s gastroenterologist will attach the Bravo capsule to the wall of your child’s esophagus (food pipe) during a procedure called an upper endoscopy. During an upper endoscopy, a thin tube with a camera at the end is inserted into your child’s esophagus.

Once in place, the Bravo capsule records how much acid comes up into the esophagus from the stomach over 48 hours. The capsule wirelessly transmits this information to a small, external, pager-sized device called a Bravo reflux recorder. The recorder is either worn by your child or placed within 3 feet of your child.

The recorded information, which typically is collected for 48 hours (sometimes longer, up to 96 hours), is downloaded onto a computer and interpreted by your child’s gastroenterologist. The Bravo capsule spontaneously falls off the food pipe within a few days and is ultimately passed in your child’s stool.

The recorded information will help your gastroenterologist determine how much acid reflux your child has and whether the reflux correlates with symptoms such as coughing or vomiting.

What is gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD)?

Gastroesophageal reflux (GER) or “acid reflux” refers to when stomach contents (such as breastmilk, infant formula, food, and stomach acid) come back up into the esophagus (food pipe).

Most healthy children and adults experience some GER throughout the day. Normal reflux is usually brief, does not cause symptoms, and generally does not lead to medical problems.

However, when GER episodes are long or frequent, a child may feel uncomfortable symptoms, including heartburn, stomach aches, vomiting, or persistent cough. GER associated with clinical symptoms is called gastroesophageal reflux disease (GERD). Prolonged or excessive reflux can sometimes cause complications such as feeding difficulties, abdominal pain, or poor weight gain.

Why might a child need the Bravo capsule test?

A doctor can usually diagnose GERD based on your child’s symptoms. Symptoms can vary for children of different ages, including excessive “spitting up” in an infant, frequent vomiting in a young child, upper abdominal pain in a school-age child, or classic “heartburn” in an adolescent.

In most cases, GERD can be clinically diagnosed, and specialized testing is not needed. However, there are some instances where specialized testing such as the Bravo capsule is helpful in children 4 years of age and older.

Some reasons why a doctor might recommend this test are:

  • In a child with chronic and persistent symptoms, such as choking, noisy breathing, chest pain, and abdominal pain, or if a GERD diagnosis is questionable
  • When it is important to figure out if certain symptoms are related to GERD, such as a child’s chronic cough or poorly controlled asthma

What preparation is needed before a Bravo capsule test?

Your child will be advised to eat a regular diet the day before testing, although he or she should avoid excessively acidic foods such as tomato-based foods, juices, carbonated beverages, and spicy foods.

Your child will need to fast immediately before the endoscopy. Your child’s medical team will discuss how long to fast (usually nothing after midnight the night before the test in older children).

Ideally, all acid-reducing medications should be discontinued a few days before the test. Your physician will tell you when to stop giving your child medications. Avoid giving your child aspirin or aspirin-like medicines (such as Advil, Motrin, Naprosyn) for a week before the procedure. Acetaminophen (Tylenol) is usually okay.

How is the Bravo capsule test performed?

The test is performed by a pediatric gastroenterology physician (GI doctor) during an upper endoscopy, with the child asleep. During an upper endoscopy, the doctor attaches the capsule to the lower part of the esophagus, usually just above where the esophagus meets the stomach. This is not painful for your child.

During the endoscopy, the doctor may also take small tissue samples called biopsies from the lining of the esophagus, stomach, and duodenum (upper part of the small intestine). Your doctor will discuss this before the procedure.

After the procedure, your child will recover for a short while and then will be able to go home on the same day. During this time, the nurse will provide instructions about how to wear, position, and use the Bravo recorder device. You may be asked to record certain aspects of your child’s activity (such as when he/she eats and goes to sleep) in a diary.

Children can resume normal diet and activity as soon as they are awake and alert following the procedure. The recording is usually performed for 48 hours.

What should I expect after the Bravo test?

Your child will be encouraged to maintain a regular day, participating in normal activities like schoolwork, play, meals, and sleep. This is to allow symptoms to occur and to capture information about GER activity as completely as possible.

Your child should eat a mostly regular diet. However, it is generally recommended to avoid acidic foods and juices, carbonated beverages, and excessively hot or cold liquids.

Some children may feel a vague sensation of “something” in their food pipe, especially when they eat food. This sensation is from the food passing by the capsule—this is okay, and parents shouldn’t be alarmed. Children should be advised to chew food thoroughly, eat slowly, and drink plenty of fluids to help minimize this sensation.

During the period of recording, parents should assist the child in recording events and symptoms on the recorder device as well as manually in a diary. The recorder should be handled with care—don’t drop it, get it wet, or turn it off, and always keep it within 3 feet of the child’s body.

Your child may take a shower or bath, but the recorder device should be kept away from water. The recorder should be returned to the GI doctor’s office after testing. The recorded information will be downloaded and interpreted by your physician, who will provide results in 1–2 weeks.

The capsule will ultimately pass out of your child’s body with a bowel movement. Please note that the Bravo capsule contains a small magnet, so any magnet-based test (such as a magnetic resonance imaging or MRI) should not be performed for at least 30 days after placement of a Bravo capsule.

What are risks of the Bravo test?

Overall, the Bravo capsule test is safe. Your child may experience a vague sensation of the Bravo device in his/her chest, especially during eating, although this sensation can be improved by eating small bites and drinking liquids.

Rare complications include severe chest pain, perforation (going through the esophagus wall), gastrointestinal bleeding, vomiting, premature detachment of the Bravo capsule from the esophagus, equipment malfunction, or poor-quality recordings. However, these side effects are very rare in experienced centers.

North American Society for Pediatric Gastroenterology, Hepatology and Nutrition
The Association of Pediatric Gastroenterology and Nutrition Nurses
North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Foundation
The NASPGHAN Council For Pediatric Nutrition Professionals
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