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  • Title: Comparison of wireless 48-h (Bravo) versus traditional ambulatory 24-h esophageal pH monitoring.
    Author: Håkanson BS, Berggren P, Granqvist S, Ljungqvist O, Thorell A.
    Journal: Scand J Gastroenterol; 2009; 44(3):276-83. PubMed ID: 19040176.
    Abstract:
    OBJECTIVE: To compare wireless with catheter-based esophageal pH recordings. MATERIAL AND METHODS: Forty-five patients with symptoms suggestive of gastroesophageal reflux disease and 47 healthy volunteers were investigated in a university-affiliated hospital; 48-h wireless esophageal pH recording was performed. During the first 24 h, simultaneous traditional pH recording by catheter was undertaken. Nine of the volunteers underwent repeated measurements with both techniques. Outcome measures were feasibility, agreement, concordance of diagnostic yield, reproducibility, and subjective symptoms. RESULTS: Subjective parameters were less affected when using the wireless technique alone (p<0.05). On using the wireless technique, esophageal acid exposure was underestimated approximately by half compared with traditional recording (p<0.05). Although pH data obtained with the two techniques were correlated (r(2)=0.66, p<0.001), the range between limits of agreement was wide (-3.7 to 10.0 percentage units of total time pH <4). Coefficients of variation for repeated measurements were 60.1+/-26.3% for catheter recordings, and 66.0+/-47.3 for wireless recordings on day 1 (NS). Concordance of diagnostic yield was 81.5% with all subjects included. CONCLUSIONS: Forty-eight-hour wireless Bravo pH monitoring is feasible but consistently underestimates esophageal acid exposure compared to the conventional technique. Although there is a significant correlation between the two techniques for pH recordings, the wide range in limits of agreement and the large coefficient of variation with both techniques suggest that the two methods are not immediately interchangeable for use in clinical practice.
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