St Vincent's the first to offer catheter-free testing
for Reflux in NSW

Bravo for St Vincent’s Clinic The Diagnostic Endoscopy Centre at St Vincent’s Clinic is the first in NSW to offer catheter-free testing for reflux. The pH testing technology, known as the Bravo pH probe, measures oesophageal acid exposure and improves diagnosis of reflux. 

‘Reflux disease affects about 10 per cent of all adults in western countries,’ says Dr Reginald V. Lord of St Vincent’s Hospital and St Vincent’s Clinic. ‘It occurs when excessive amounts of stomach or gastric juice travel up into the oesophagus, the tube through which food passes from the mouth to the stomach. The main symptom of excessive reflux is heartburn; a burning discomfort or pain, usually in the lower chest.’

The most effective way to diagnose reflux disease is through an ambulatory pH monitoring study, which measures the amount of acid reflux in the oesophagus over 24-48 hours. The idea of ambulatory monitoring is to measure pH on a typical day, doing typical things; going to work, eating, sleeping and relaxing. 

The catheter-free Bravo pH probe is a major step forward in the accurate diagnosis of reflux disease. ‘Before the introduction of the Bravo system, to measure pH required inserting a catheter through the nose into the oesophagus for 24 hours,’ says Dr Lord. ‘However, having a catheter in the nose often leads to discomfort and embarrassment and many patients stay home and rest instead of going about their daily business. This in turn can result in misleading test results which reflect lower than normal reflux.’

Because the Bravo probe is a catheter-free system, patients are more likely to go about their day uninhibited and it is easy to perform a more thorough 48-hour study. This provides a more realistic picture, which allows for a more accurate diagnosis and treatment.  The Bravo system uses a miniature pH recording capsule, the size of a regular aspirin capsule. It is attached to the lining of the oesophagus while patients are sedated. ‘The capsule transmits the pH information to a receiver worn on a belt like a pager or mobile phone. Patients press a button on the receiver when they experience heartburn or other symptoms and record times of meals, sleep and other events in a simple diary,’ explains Dr Lord.  

At the end of the 48-hour period the information from the receiver is uploaded to a computer for a detailed reflux analysis. The probe spontaneously sloughs off after about one week.

As well as heartburn and acid regurgitation, other symptoms which can be caused by reflux disease include pain or difficulty swallowing; chest or upper abdominal pain; bloating; chronic hoarse voice and cough; throat clearing; dental erosion; and wheezing and shortness of breath. Respiratory symptoms can be worse at night, sometimes causing the sufferer to wake up with choking, coughing or other distressing symptoms. ‘The acid juices in the stomach are normally prevented from refluxing into the oesophagus by the sphincter or valve at the lower end of the oesophagus,’ explains Dr Lord. ‘Reflux disease occurs if this lower oesophageal sphincter is permanently weak or if it relaxes excessively.’ Dr Lord also performs manometry studies which measure the pressure in this sphincter, as well as oesophageal motility studies which measure muscle contraction abnormalities in the tubular part of the oesophagus. Oesophageal dysmotility can also contribute to reflux.  

‘A small amount of reflux is normal. Most people with reflux disease will only suffer the common symptoms,’ says Dr Lord. ‘Those with more severe reflux, especially if they have had the disease for years, can develop complications. These include ulcer, possibly with bleeding, narrowing of the oesophagus and difficulty swallowing. Some people can have serious respiratory complications, including recurrent lung infections and chronic lung diseases.’ Other complications of more severe, longstanding reflux include the development of Barrett’s oesophagus, a condition in which the cells lining the lower oesophagus change to an abnormal shape. 

‘Reflux disease is usually a chronic illness requiring continuous or intermittent lifelong therapy. For this reason, it is important to accurately diagnose this disease in affected individuals,’ says Dr Lord. Equally, many patients who have been diagnosed with reflux disease and have been prescribed anti-reflux medications don’t have the disease and could stop taking these medicines. Accurate diagnosis is essential for proper treatment.

Dr Lord trained in general surgery at St Vincent’s Hospital after which he spent over five years at the University of Southern California. As a Fellow at USC, he trained in oesophageal function testing before joining the faculty as Assistant Professor and Attending Surgeon, with Dr Tom DeMeester. Dr DeMeester is the pioneer of ambulatory oesophageal pH testing. Dr Lord has been at St Vincent’s Hospital and St Vincent’s Clinic since late 2004.   back to top 

The Bravo system uses a miniature pH recording capsule, the size of a regular aspirin

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