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Does the Catheter-Free Bravo™ pH Capsule Alter Esophageal Motor Function?

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Zhang, Qing, M.D., Ph.D.; Boniquit, Christopher T., B.S.; Ghosh, Sudip K., Ph.D.; Pandolfino, John E., M.D.; Jarosz, Andrew F.; Kahrilas, Peter J., M.D.

American Journal of Gastroenterology: September 2005 - Volume 100 - Issue - p S42
Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
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Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, IL.

Purpose: Whether attachment of the Bravo™ catheter-free pH monitoring system alters esophageal motility has yet to determined. The aim of this study was to assess the effect of the Bravo™ capsule on esophageal motor function using high-resolution manometry (HRM) before and after placement.

Methods: 10 controls (5 males, age 20–54) were studied. A solid-state manometric assembly with 36 circumferential sensors spaced 1 cm apart was positioned to record from the hypopharynx to the stomach (Sierra Scientific Inc). Esophageal manometry studies were performed before and ≥12 hours after the Bravo™ capsule placement. The subjects performed 5 5-ml water swallows in both upright and supine positions. Two 5-ml barium swallows were also performed in 6 subjects under fluoroscopy synchronized with manometry recordings.

Results: There was no significant change in basal LES pressure, LES relaxation pressure or peristaltic function before and after Bravo™ placement in both positions(Table). However, a noticeable 1.5 cm high-pressure focus was noted during peristalsis at the location of the capsule during fluoroscopy. The mean peristaltic pressure at the Bravo™ capsule attachment site was increased in both positions, however, statistical significance was only reached in the upright position (Upright, 59.4 ± 10.5 mmHg vs. 134.1 ± 20.2 mmHg, p < 0.005; Supine, 111 ± 15 mmHg vs. 141.3 ± 19.8 mmHg, p > 0.2), Five out of ten subjects reported symptoms during eating (foreign body sensation 4, chest pain 1). Although the median pressure increase at the attachment site was increased in the 5 subjects with symptoms, it was not statistically significant (Symptoms, 76.2 mmHg (IQR, 51.0); No symptoms, 57.5 mmHg (IQR, 50.10, p > 0.05).

Table: E

Table: E

Conclusions: Bravo™ placement does not alter standard manometric parameters assessing esophageal function. The regional manometric changes noted at the capsule attachment site are relegated to a short segment of the esophagus and should not alter bolus clearance. However, this short area of increased peristaltic amplitude may be an important factor in determining individual's comfort during the recording period.

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