🧒📡 Bravo Capsule Test (Wireless pH Study) in Children: A Parent-Friendly Guide

✅ The Bravo capsule test is a wireless pH study that measures acid reflux in the esophagus without a tube coming out of the nose.
A tiny capsule is placed onto the esophagus lining (usually during an endoscopy) and it sends pH data to a recorder for 48–96 hours (center-dependent).
It helps doctors understand if acid reflux is truly causing your child’s symptoms (heartburn, chest pain, chronic cough, throat symptoms).

1) 🧾 Quick “At-a-glance” box (top of page)

✅ Test name: Bravo capsule pH test
Common names: Bravo study, wireless pH monitoring, capsule pH test

Plain-language summary (2–3 lines):
The Bravo capsule measures how much acid reaches the esophagus over several days while your child lives normally. It is useful when symptoms come and go, or when we need stronger proof of acid reflux. The capsule naturally falls off and passes in stool.

Who it affects (typical ages):
Usually older children and teens, but can be used in selected younger children depending on center and anatomy.

✅ What parents should do today:

• Ask why Bravo is preferred over a catheter pH study
• Confirm if reflux medicines must be stopped and for how long
• Plan for a “normal life” study day (normal meals and activity)
• Understand the device rules (keeping the recorder close; avoiding certain medical tests temporarily)

⚠️ Red flags that need urgent/ER care (rare):

• Severe chest pain that doesn’t settle
• Trouble swallowing with drooling or inability to drink
• Vomiting blood or black stools
• Breathing trouble

🟡 When to see the family doctor/clinic:

• Questions about prep and medication timing
• Ongoing discomfort after placement
• Persistent feeding refusal

2) 🧠 What it is (plain language)

Bravo is like a tiny “acid meter” that sits on the inside lining of the esophagus.

It records:

• how often acid reaches the esophagus
• how long episodes last
• overall acid exposure over 2–4 days (depending on center)

It does not measure:

• non-acid reflux (impedance is needed for that)
• swallowing function

What part of the body is involved? (small diagram required)

::contentReference[oaicite:0]{index=0}

Common myths vs facts

• Myth: “The capsule stays inside forever.”
  Fact: It falls off naturally and passes in stool.
• Myth: “If there’s no tube, the test is not accurate.”
  Fact: It can be very accurate for acid reflux.
• Myth: “A normal test means symptoms aren’t real.”
  Fact: Symptoms are real; a normal test helps redirect evaluation.

3) 🧩 Why it’s ordered (questions it answers)

Bravo helps answer:

• Is acid reflux happening often enough to explain symptoms?
• Are symptoms linked to acid events?
• Is long-term acid suppression needed?
• Is surgery being considered, and do we need objective proof?

Common reasons

• heartburn or chest pain
• reflux symptoms that come and go
• persistent symptoms despite treatment (need confirmation)
• evaluation before anti-reflux surgery (selected cases)

Less common but important reasons

• chronic cough/hoarseness where reflux is suspected and objective data is needed

4) 👀 What parents might notice (symptoms leading to Bravo)

• heartburn, sour taste
• chest pain (burning)
• nausea
• regurgitation
• throat clearing/hoarseness
• chronic cough (selected cases)

What’s normal vs what’s not

🟢 Often mild:

• occasional heartburn after trigger foods

⚠️ Concerning:

• weight loss
• vomiting blood / black stools
• trouble swallowing (food sticking)
• severe chest pain

Symptom tracker during the study

• meals/snacks (time + what)
• symptom times and severity
• sleep times
• activity/exercise

5) 🏠 Preparation & what helps (step-by-step)

✅ Good prep makes the test meaningful.

24–48 hours (or longer) before the test

✅ Do this now:

• Ask exactly which medicines must be stopped and when:
  • PPIs may need several days off (varies)
  • H2 blockers and antacids have different stop times
• Plan normal foods (unless told otherwise)
• Review endoscopy instructions if placement is during endoscopy

Day of placement

• capsule is usually attached during endoscopy
• your child goes home with a small recorder

During the study (48–96 hours)

• live normally (this is the point!)
• keep recorder close as instructed
• log symptoms and meals

Comfort tips

• mild “something there” feeling can happen
• encourage normal swallowing and fluids
• avoid very sticky/hard foods for the first day if advised

6) ⛔ What NOT to do (common mistakes)

• Don’t avoid all trigger foods if your team wants a normal diet.
• Don’t forget to log symptoms and meals.
• Don’t let the recorder get too far from your child (data loss).
• Don’t schedule certain medical imaging/tests without checking (some restrictions may apply temporarily).

7) 🚦 When to worry: triage guidance

🔴 Call 911 / Emergency now

• severe breathing difficulty
• collapse or severe weakness

🟠 Same-day urgent visit

• severe chest pain that persists
• cannot swallow liquids
• vomiting blood or black stools

Example: “My child can’t swallow and is drooling after the procedure.”

🟡 Book a routine appointment

• mild discomfort that persists beyond expected timeframe
• questions about results

🟢 Watch at home

• mild throat or chest awareness that improves within a day or two

8) 🩺 How doctors do it (what to expect)

Placement

• usually during endoscopy (while sleepy/asleep with anesthesia)
• capsule attaches to esophagus lining

Monitoring period

• 2–4 days (center-dependent)
• your child returns the recorder

What doctors analyze

• acid exposure time
• number/duration of acid events
• symptom correlation patterns

9) 🧰 Treatment options (what happens after results)

✅ Bravo results can prevent unnecessary long-term medicines—or confirm the need for treatment.

If acid reflux is high and correlates with symptoms

• optimize lifestyle/meal timing
• adjust acid suppression medicines (type, timing, dose)
• consider endoscopy findings (esophagitis)
• in selected cases, surgery discussion

If acid reflux is low/absent

• taper acid medicines (with guidance)
• evaluate other causes:
  • functional pain
  • anxiety/stress physiology
  • eosinophilic esophagitis (EoE)
  • motility disorders
  • airway/asthma conditions

Severe cases

• objective evidence may support specialized interventions when symptoms are serious

10) ⏳ Expected course & prognosis

• most children tolerate Bravo well
• capsule falls off naturally and passes in stool (you usually don’t notice)
• longer monitoring improves accuracy for intermittent symptoms

11) ⚠️ Complications (brief but clear)

Common (mild)

• mild chest discomfort
• “something stuck” feeling briefly

Rare but important

• significant chest pain
• trouble swallowing
• bleeding (very rare)

12) 🛡️ Prevention and reducing future episodes

• avoid late-night meals
• treat constipation
• maintain healthy weight in older children
• avoid smoke exposure
• identify true triggers after objective diagnosis

13) 🌟 Special situations

Teens

Caffeine/energy drinks and late eating often worsen symptoms.

Kids with swallowing concerns

May not be candidates for Bravo; the team will decide.

Neurodevelopmental differences

May be difficult to tolerate; catheter alternatives may be chosen.

Travel considerations

Avoid travel far from the center during the first 24 hours after endoscopy if advised.

School/daycare

Usually fine; child just carries/keeps the recorder nearby.

14) 📅 Follow-up plan

• return recorder as instructed
• review results with GI team
• decide:
  • medication plan
  • need for endoscopy follow-up
  • whether other conditions should be evaluated

15) ❓ Parent FAQs

“Is it contagious?”

No.

“Can my child eat ___?”

Usually yes. Some centers advise avoiding very sticky/hard foods for a short time.

“Can they bathe/swim/exercise?”

Ask your center—some allow showers, but swimming is usually avoided while wearing the recorder.

“Will they outgrow it?”

Many reflux patterns improve with age; results help guide safe tapering.

“When can we stop treatment?”

After results, your clinician may taper or stop medicines if acid reflux is not significant.

16) 🧾 Printable tools (high-value add-ons)

🧾 Printable: Bravo Capsule Test Checklist

Before:

• Confirm medication stop/start plan
• Review endoscopy fasting instructions
• Plan normal meals for study days

During:

• Keep recorder close
• Log meals/symptoms with times
• Follow center food/activity rules

Urgent:

• Severe chest pain
• Cannot swallow liquids
• Vomiting blood / black stools

🧾 Printable: Meal & Symptom Log

Date: ______
Time: ______ Meal: ______
Time: ______ Symptom: ______ Severity (0–10): ______
Sleep: ______ to ______

🧾 Printable: “Red Flags” Sheet

⚠️ Urgent: severe chest pain, can’t swallow liquids, vomiting blood, black stools, breathing trouble.

17) 📚 Credible sources + last updated date

Trusted references:

• Children’s hospital reflux testing education pages
• Pediatric GI society patient resources on reflux evaluation

Last reviewed/updated on: 2025-12-31
Medication stop times and monitoring duration vary by center—follow your team’s instructions.

🧡 Safety disclaimer

This guide supports—not replaces—medical care. If you are worried about your child, trust your instincts and seek urgent medical assessment.

This guide was fully developed & reviewed by Dr. Mohammad Hussein, MD, FRCPC ROYAL COLLEGE–CERTIFIED PEDIATRICIAN & PEDIATRIC GASTROENTEROLOGIST Board-certified pediatrician and pediatric gastroenterologist (Royal College of Physicians and Surgeons of Canada) with expertise in inflammatory bowel disease, eosinophilic gastrointestinal disorders, motility and functional testing, and complex nutrition across diverse international practice settings.

To book an online assessment Email Dr. Hussein’s Assistant Elizabeth Gray at: Elizabeth.Gray@pedsgimind.ca
In the email subject, please write: New Assessment Appointment with Dr. Hussein

Important: This appointment is completely online as Dr. Hussein is currently working overseas. This service is not covered by OHIP