New procedure targets causes of chronic acid reflux

Gastroesophageal reflux disease, which affects millions of people, is when stomach acid flows up into the esophagus. This creates heartburn, chest pain, coughing and sometimes even more serious symptoms, including difficulty swallowing and vomiting.

However, there are many causes of GERD, so figuring out the cause is key to prescribing the appropriate treatment. For some, the condition can be managed with lifestyle changes or medication. Others may need surgery.

The Bravo pH test, introduced in May at the Milwaukee VA, uses cutting-edge technology to better diagnosis the cause of GERD. It requires embedding a small capsule to the esophageal lining during an endoscopic procedure. The capsule records pH data over 96 hours, and that data is transmitted wirelessly to a monitor worn by the Veteran. 

The capsule then falls off and is eventually passed through the digestive system. The collected data helps doctors figure out what is happening in the stomach when the patient experience GERD symptoms, which leads to the most appropriate treatment.

“We’re really excited to be able to offer this at our VA,” said GI Lab Registered Nurse Kristin Olson, noting that previously, Veterans had to be sent to a hospital in the community for the procedure.

“This technology is easier for the patient, and more reliable,” said gastroenterologist Dr. Francis Edeani.

Previously, this type of testing required inserting a probe through the patient’s nose and down into the esophagus. While not only uncomfortable and bothersome, that procedure produced only 24 hours’ worth of data.

With the Bravo pH test, a Veteran can continue to lead a normal life while the capsule is in place. The only requirement is that the monitor, which is about the size of a person’s fist, be kept nearby at all times.

The capsule attaches to the esophagus through suction, and there is very little discomfort, Edeani said.

“I usually tell patients they may feel something there when they swallow, but it’s not painful,” he said.

The symptoms of GERD can be triggered by many things, including smoking, obesity and certain types of food. Sometimes the cause is a hiatal hernia, which is when the upper part of the stomach pushes through the hiatus, which is like a doorway between the stomach and esophagus. 

Also, as people age, the hiatus may weaken, allowing acid to creep into the esophagus.

While a hiatal hernia may require surgery, the other causes can usually be controlled through medications, such as proton pump inhibitors, and lifestyle changes.

The Bravo pH test helps determine if acid reflux is causing the patient’s discomfort.

“Sometimes a patient will have symptoms but not have acid reflux,” Olson said.

Edeani agreed, saying sometimes patients feel like they’re having a heart attack and end up in the Emergency Department.

“And they go through all this testing, which shows that their heart is fine. They just had really bad heartburn,” he said. 

“That’s why this test is a nice tool to have. … If there isn’t significant acid reflux (during the testing period), then we can look for alternative causes.”

The Bravo pH testing is available now. Olson said the demand is there, noting that about four patients a month would qualify. 

“This is something that we’ve always wanted,” Edeani said. “With us having this here, we don’t have to send the patient out to another hospital for the procedure. It’s great to have it here. It’s a huge step forward.”