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Clinical Utility of the Bravo Capsule

22

Dukowicz, Andrew C. MD; Lacy, Brian E. PhD, MD; Paquette, Lisa RN; Robertson, Douglas MD; Weiss, Julia MA; Kelley, Maurice L. MD

American Journal of Gastroenterology: September 2006 - Volume 101 - Issue - p S48–S49
Abstracts: ESOPHAGUS
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Gastroenterology & Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Medicine, White River VA Medical Center, White River Junction, VT and Biostatistics, Dartmouth Medical School, Hanover, NH.

Purpose: The Bravo capsule is commonly ordered to evaluate patients (Pts) with acid reflux symptoms. Despite its widespread use, the clinical utility of the Bravo capsule has not been prospectively examined.

Methods: Before placing the Bravo capsule, referring physicians (GIs, surgeons, primary care) prospectively completed a questionnaire requesting: indications for the test (primary and secondary); symptoms (primary and secondary; duration); prior testing for the problem; and medication use. Demographic information was obtained. Patients were studied either on or off acid-suppressing medications at the referring provider's request. Two weeks after the referring physician received the results of the test a follow-up questionnaire was sent asking whether the Bravo capsule provided new information that either changed the Pt's diagnosis or management. Results of Bravo were classified using standard criteria.

Results: During a 6 month period, 275 Bravos were performed; 240 were available for inclusion; 106 fully completed questionnaires were returned (44.2%) and are the basis for this analysis. The mean age (±SD) at time of Bravo placement was 47 (±16 years); 66% were women. 95% of patients were Caucasian. The average age of onset of symptoms was 40 years (±15). The most common primary symptom leading to referral was that of acid reflux symptoms (heartburn and regurgitation; 65%), followed by chest pain or a chronic cough (both 9%), dysphagia (5%), and ENT symptoms (3%). The average duration of symptoms was 70 months. 91% of patients had undergone prior testing for their symptoms, including EGD, barium swallow, and/or chest x-rays. 27% had undergone a previous pH test (either pH catheter or Bravo). In all, 61% of these studies were abnormal. Results of the Bravo capsule provided new information in 75% of patients and changed the diagnosis in 25% of patients. Results of the Bravo study led to a change in management in 64% of patients. Management changes included: referral to surgery (26%), stopping a prior medication (18%), increasing dose of a prior medication (12%), adding a new medication (12%) and other (32%).

Conclusions: This is the first study to prospectively evaluate the clinical utility of the Bravo capsule. It appears to be a clinically useful test as it frequently provides new information and leads to a change in Pt diagnosis or management.

© The American College of Gastroenterology 2006. All Rights Reserved.