Concierge gastroenterology · London
Bravo Alpha oesophageal pH test, a catheter-free 48-96 hour wireless capsule for reflux diagnosis.
The Bravo Alpha is a small wireless capsule attached to the oesophagus at endoscopy that transmits pH data for 48-96 hours. Catheter-free — patients eat, sleep and exercise normally. Modern alternative to 24-hour ambulatory pH catheters.
Why patients choose us
- 01
The right hands
We route you to a consultant gastroenterologist experienced with wireless pH capsule placement and Lyon Consensus interpretation.
- 02
A modern alternative
Bravo Alpha replaces the nasal catheter for many patients — 48-96 hours of physiological recording without a tube in the throat.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Key facts
What the Bravo Alpha test actually is.
A wireless capsule attached at gastroscopy that records oesophageal pH for up to four days — the modern replacement for the 24-hour nasal catheter.
- 01
What it is
A wireless pH-monitoring capsule attached to the oesophageal wall at gastroscopy.
- 02
How long it records
Continuously logs oesophageal pH for 48-96 hours.
- 03
Catheter-free
No nasal tube and no throat tube — you wear a small pager-sized recorder on a belt.
- 04
Live normally
Sleep, eat and exercise as usual — the reading reflects real life, not a hospital day.
- 05
DeMeester reported
The report includes the DeMeester composite score with Lyon Consensus interpretation.
- 06
Modern replacement
Now first-line over 24-hour catheter pH monitoring for most reflux indications.
Preparation
From consultation to report — what happens, in order.
Seven steps, one consultant gastroenterologist from start to finish.
Phase 1 · Before
Consult and PPI washout
Phase 2 · On the day and after
Gastroscopy plus 48-96 hour recording
Phase 3 · Report
DeMeester and Lyon Consensus
- 01
Before
Consultant gastroenterology consultation
A face-to-face or video appointment to confirm Bravo Alpha is the right test and plan sedation.
- 02
Before
Stop PPI 7 days pre-test
Proton pump inhibitors are stopped a full week before, unless the on-treatment protocol is chosen.
- 03
On the day
Attend for gastroscopy
Same-day admission for an upper GI endoscopy — sedation or throat spray as agreed.
- 04
On the day
Capsule attached to oesophagus
The consultant places the wireless capsule 6 cm above the gastro-oesophageal junction.
- 05
On the day
Wear recorder for 48-96 hours
Carry the pager-sized recorder on a belt and press buttons for reflux, meals and sleep.
- 06
After
Return the recorder
Post or drop the recorder back — the capsule detaches naturally within a few days.
- 07
After
Report with DeMeester and Lyon criteria
A written report with acid exposure time, DeMeester score and Lyon Consensus classification.
Typical end-to-end: 2-3 weeks including a 7-day PPI washout.
What it shows
The metrics on your Bravo Alpha report.
Each metric answers a different question about your reflux — how much, how long, when, and whether it correlates with your symptoms.
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Total acid exposure time (%)
The proportion of the recording spent below pH 4 — the headline reflux metric.
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Number of reflux episodes
Total reflux events over 48-96 hours, split by upright and supine.
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Longest reflux episode
Duration of the single longest acid exposure — a marker of clearance failure.
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Nocturnal reflux burden
Supine and overnight acid exposure — the strongest predictor of complications.
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Symptom-reflux correlation (SAP / SI)
Whether your recorded symptoms line up with actual reflux events on the trace.
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DeMeester score
A composite score combining six pH variables — the standard reflux benchmark.
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Detached-capsule artefact
Identified and excluded from analysis so the report reflects true oesophageal pH.
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Red flag: severe acid exposure + Barrett’s findings on endoscopy — oncology surveillance pathway
Severe reflux with Barrett’s at endoscopy triggers surveillance and oncology referral.
Next steps
What the report unlocks.
The pH data doesn’t just diagnose reflux — it selects the right onward pathway, from a PPI tune-up to fundoplication.
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Reassurance if normal
A physiological trace with normal acid exposure often ends the reflux work-up.
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Optimise PPI therapy
Dose, timing and choice of PPI adjusted around meals for better acid suppression.
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Add H2-blocker or alginate
A bedtime H2-blocker or alginate raft on top of PPI for nocturnal breakthrough reflux.
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Weight loss and lifestyle advice
Weight reduction, evening meal timing, head-of-bed elevation and trigger avoidance.
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Anti-reflux surgery (fundoplication / LINX)
Referral to an upper GI surgeon for laparoscopic fundoplication or magnetic sphincter augmentation.
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TIF endoscopic anti-reflux procedure
Transoral incisionless fundoplication — a scarless endoscopic option for selected patients.
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Neurogastroenterology referral
For functional heartburn and reflux hypersensitivity when pH is normal but symptoms persist.
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Barrett’s surveillance pathway
Enrolment in a structured Barrett’s surveillance programme with interval gastroscopy.
Red flags and caveats
When Bravo Alpha is not the whole answer.
Bravo Alpha is a pH test — for motility, non-acid reflux, or complications, other tests come into play.
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Barrett’s oesophagus with dysplasia
Confirmed dysplasia changes the pathway to endoscopic surveillance or eradication therapy.
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Grade C or D oesophagitis
Severe erosive oesophagitis on gastroscopy warrants aggressive acid suppression and follow-up.
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Refractory reflux post-fundoplication
Persistent symptoms after anti-reflux surgery need combined pH-impedance and manometry.
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Concomitant achalasia (needs HRM)
Suspected motility disorder — high-resolution manometry is the correct next test.
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Suspected extra-oesophageal reflux
ENT, laryngeal or pulmonary symptoms may need pH-impedance rather than pH alone.
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Post-bariatric surgery reflux
Altered anatomy after sleeve or bypass changes interpretation — specialist input required.
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Scleroderma oesophagus
Connective tissue disease with severe reflux — coordinated rheumatology and GI care.
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Persistent dysphagia
Swallowing difficulty is a red flag warranting urgent endoscopy and manometry.
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Alarm features
Unexplained weight loss, iron-deficiency anaemia or GI bleeding — urgent two-week-wait pathway.
Sources
The guidelines behind this page. Read them yourself.
Every claim on this page maps back to a named body — society guideline, consensus statement, or device manufacturer evidence.
Reviewed
Last reviewed 2026-07-30 · Next review 2027-07-30
Reviewed by Pulse Atlas Editorial Board, . Read time approximately 6 minutes.
- 01 Source
British Society of Gastroenterology — reflux and Barrett’s guidelines.
British Society of Gastroenterology — reflux and Barrett’s guidelines.
- 02 Source
American College of Gastroenterology — clinical guideline: diagnosis and management of GERD.
American College of Gastroenterology — clinical guideline: diagnosis and management of GERD.
- 03 Source
Lyon Consensus 2.0 — modern diagnostic criteria for gastro-oesophageal reflux disease.
Lyon Consensus 2.0 — modern diagnostic criteria for gastro-oesophageal reflux disease.
- 04 Source
Bravo reflux monitoring system — Medtronic clinical evidence library.
Bravo reflux monitoring system — Medtronic clinical evidence library.
Recognised by major UK insurers
Cover depends on your policy and clinic; we confirm with your insurer before booking.
Frequently asked
Everything we get asked about the Bravo Alpha pH test.
Quick answers on how it differs from a 24-hour catheter, PPI washout, comfort, and what happens to the capsule.
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What does a Bravo Alpha pH test show?
It measures the acidity in the lower oesophagus continuously for 48-96 hours. The report describes total acid exposure time, the number and duration of reflux episodes, the DeMeester composite score, and whether your symptoms line up with true reflux events.
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How is Bravo different from a 24-hour pH catheter?
A traditional 24-hour pH study uses a thin nasal catheter taped to your face. Bravo Alpha uses a wireless capsule clipped to the oesophageal wall at endoscopy — no catheter, no nose tube, and 48-96 hours of recording instead of 24.
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Does it hurt?
The capsule is placed under sedation at gastroscopy, so you feel nothing at the time. A mild chest awareness or foreign-body sensation is common for a day or two while the capsule is in place.
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Do I need to stop my PPI?
Usually yes — proton pump inhibitors are stopped 7 days before the test so we can measure true acid reflux. In some cases the consultant runs an on-treatment study instead, to see whether current medication is enough.
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What happens to the capsule?
It detaches from the oesophageal wall on its own within a few days to a week and passes harmlessly through the gut. You will not feel it leave.
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When would I need vascular surgery?
Not applicable to Bravo — if a fundoplication or LINX device is being considered, this test provides the reflux evidence the upper GI surgeon needs before deciding.
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Bravo pH study
The standard Bravo wireless pH study.
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24-hour pH monitoring
Traditional catheter-based ambulatory pH monitoring.
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In practice, in London
What bravo alpha oesophageal PH test looks like on the ground in London
With bravo alpha oesophageal ph test, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. The NHS route for bravo alpha oesophageal PH test is thorough, but the queue is real. Most patients we speak with have been told to expect anywhere from a handful of weeks to several months, depending on their local trust and how the referral is graded. Going private in London usually collapses that window to a matter of days — often the same week if the diary allows. It isn’t about jumping a queue so much as buying time back while you still have the flexibility to plan around it.
In practice, a private bravo alpha oesophageal PH test appointment in London means a named consultant, a proper hour in the room (or the equivalent on a video call), and a report you can actually read. Most of the imaging suites and endoscopy units we use sit within a mile of Harley Street or in Chelsea and Fulham, and turnaround on findings is measured in days, not weeks. For bravo alpha oesophageal ph test specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
The value of going through a concierge for bravo alpha oesophageal PH test isn’t access — anyone with an insurer or a credit card can get a private appointment in London. The value is knowing which consultant reads this particular presentation best, which unit turns reports around fastest, and which pathway won’t hit a dead end if the findings point somewhere unexpected.