Concierge reflux physiology · London
Bravo pH study, how the wireless capsule changes reflux diagnosis and anti-reflux surgery selection.
The Bravo pH study is a 48-96 hour wireless oesophageal pH capsule. Beyond just diagnosis, it selects the right patients for anti-reflux surgery, guides PPI de-escalation and rules out functional syndromes mimicking reflux.
- 48–96 hour wireless capsule pH study
- Selects patients for anti-reflux surgery (LINX / fundoplication)
- Documents PPI failure vs functional syndromes
- Guides PPI de-escalation
- Symptom-reflux association (SAP / SI) is often decisive
- Repeat testing at intervals to monitor treatment response
Why patients choose us
- 01
The right hands
We route you to a consultant gastroenterologist with prolonged wireless pH expertise — placement, reporting and surgical selection under one clinician.
- 02
Reads that change management
The study is only useful if the DeMeester score, SAP and SI are interpreted alongside your symptoms — that is what decides PPI, surgery or a functional pathway.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private Bravo pH study costs in London.
Indicative ranges across our partner clinics. Send the details and we quote firm figures across two or three options.
In short
A 48-hour Bravo study, inclusive of placement and report: £1,600–£2,400, with the written report within 5–7 days.
| Study type | Indicative range | Typical duration | Report turnaround |
|---|---|---|---|
| Bravo pH study (48-hour, capsule + placement + report) | £1,600–£2,400 | 48 hr | 5–7 days |
| Extended Bravo pH study (96-hour) | £1,900–£2,800 | 96 hr | 7–10 days |
| Bravo study + high-resolution manometry (pre-op work-up) | £2,400–£3,600 | 2 visits | 7–10 days |
| Post-fundoplication Bravo pH study | £1,800–£2,600 | 48 hr | 5–7 days |
| On-PPI Bravo pH study (refractory reflux) | £1,700–£2,500 | 48 hr | 5–7 days |
| Bravo + consultant follow-up (management planning) | £2,000–£3,000 | 48 hr | 7–10 days |
Prices vary by clinic, whether extended 96-hour recording is used, and whether high-resolution manometry or a management follow-up is bundled in. We come back with a firm quote within one working day.
The problem
The Bravo study is only useful if it changes the plan.
The numbers are the answer — DeMeester, SAP and SI — and the person interpreting them decides whether you continue PPI, go to LINX or fundoplication, or take the functional-heartburn pathway. We route you to a consultant gastroenterologist who does all three.
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Persistent reflux on PPI?
We arrange an on-therapy Bravo to quantify true breakthrough acid exposure.
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Considering LINX or fundoplication?
We deliver an off-PPI Bravo with a symptom diary, so surgical selection is grounded in physiology.
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Reflux returned after surgery?
A post-fundoplication Bravo objectively assesses the wrap and directs revision or medical care.
Preparation and journey
From consultation to report — what happens, in order.
One consultant from first message to reported study — usually inside two weeks.
Phase 1 · Before your study
Consultation and PPI washout
Phase 2 · During recording
48–96 hours with the recorder
Phase 3 · After
Report and management plan
- 01
Before
Consultant gastroenterology consultation
A private consultant confirms the study is the right test, and reviews your reflux history, red flags and current medications.
- 02
Before
Stop PPI 7 days pre-test
Proton pump inhibitors are stopped seven days before the capsule is placed, unless the study is deliberately on-therapy.
- 03
Before
Attend gastroscopy
The Bravo capsule is placed under sedation at gastroscopy, so any mucosal disease is inspected at the same visit.
- 04
During recording
Wireless capsule attached to oesophagus
The capsule is pinned to the distal oesophagus and transmits pH wirelessly to a small recorder you carry.
- 05
During recording
Wear recorder 48–96 hours (patient diary)
You eat, sleep and work as normal, logging symptoms, meals and posture in the patient diary that anchors the analysis.
- 06
After
Return recorder
The recorder is returned to the clinic; the capsule sloughs off naturally within a few days and passes without you noticing.
- 07
After
Written report — DeMeester and Lyon
A consultant-signed report against the DeMeester composite score and Lyon Consensus criteria, with a concrete management recommendation.
Typical end-to-end: 10–14 days. Urgent slots: within one week.
What it shows
What a Bravo pH study measures — and what those numbers mean.
A pH study answers a specific set of questions — how much acid, when, and whether it matches your symptoms. The eight metrics below are the ones that change management.
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Total oesophageal acid exposure time
The proportion of the study spent with distal oesophageal pH below 4 — the single most decisive number.
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DeMeester composite score
A weighted composite of six pH parameters; the traditional threshold above which pathological reflux is confirmed.
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Symptom association probability (SAP)
Statistical link between your logged symptoms and reflux events — decisive when acid exposure is borderline.
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Symptom index (SI)
The proportion of symptom episodes matched to a reflux event within the analysis window.
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Nocturnal reflux burden
Supine acid exposure — the pattern most tightly linked to erosive disease, Barrett’s and extra-oesophageal syndromes.
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PPI-responsive vs PPI-refractory reflux
On- or off-therapy studies distinguish true refractory reflux from inadequately treated disease.
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Functional heartburn / hypersensitive oesophagus
A normal DeMeester with a positive SAP defines oesophageal hypersensitivity — a different treatment pathway entirely.
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Red flag: severe reflux + Barrett’s on endoscopy — surveillance pathway
If placement gastroscopy shows Barrett’s, you enter a formal surveillance pathway with biopsy and interval review.
Study types
Not every Bravo study answers the same question.
What each option on your referral is actually for.
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48-hour Bravo pH study
The standard prolonged wireless capsule study — two full days of pH data, off PPI.
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96-hour extended Bravo
Extended recording captures day-to-day variability and lifts the diagnostic yield when symptoms are intermittent.
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Off-PPI diagnostic study
Confirms or excludes pathological acid exposure in patients not yet committed to long-term PPI.
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On-PPI refractory-reflux study
Quantifies breakthrough acid exposure in patients whose symptoms persist despite optimised PPI therapy.
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Pre-anti-reflux-surgery study
The definitive test to select patients for LINX or fundoplication — abnormal acid exposure plus a positive SAP.
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Post-fundoplication surveillance
Objective assessment of the wrap when reflux symptoms recur after surgery.
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Pre-bariatric reflux assessment
Documents baseline reflux before sleeve gastrectomy or bypass, where post-operative reflux is a known risk.
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Bravo + high-resolution manometry
Paired physiological work-up: pH plus motility, to plan the correct anti-reflux procedure.
Our vetted London network
A small panel of clinics, we picked them.
Partners across central, north, west and south London. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every clinic in our network.
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Consultant gastroenterologists with prolonged wireless pH and reflux-surgery selection experience
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Reporting against DeMeester composite score and Lyon Consensus criteria
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Placement gastroscopy performed at the same visit, with mucosal disease documented
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Onward LINX, fundoplication or neurogastroenterology pathway if the study directs it
Safety and eligibility
A well-tolerated test — with a short list of caveats.
The Bravo capsule is well tolerated and the risks are small. The practical points are which patients are suitable, what to stop, and which alarm features go straight to endoscopy.
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Placed under sedation at gastroscopy
The capsule is pinned to the distal oesophagus during a standard sedated gastroscopy.
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Capsule passes naturally
The capsule detaches within a few days and passes through the gut without you noticing.
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No MRI while capsule in situ
MRI must be avoided until the capsule has passed — usually within 30 days.
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Stop PPI 7 days pre-test
PPIs are stopped a week before an off-therapy study; alginates and antacids on a shorter washout.
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Keep a symptom diary
The diary is not optional — SAP and SI are only meaningful when symptoms, meals and posture are logged.
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Small risk of chest discomfort
A minority of patients feel the capsule as a mild retrosternal awareness; it settles as the capsule detaches.
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Not for suspected varices or strictures
Placement is avoided in patients with oesophageal varices, tight strictures or coagulopathy.
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A normal study is not a full clear
A normal pH study does not exclude weakly-acidic or non-acid reflux — impedance-pH may still be needed.
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Alarm features go to endoscopy first
Dysphagia, weight loss or GI bleeding go to urgent endoscopy and biopsy, not a pH study.
Red flags — a Bravo study alone is not enough
The clinical scenarios below need a wider work-up — combined manometry, impedance-pH, urgent endoscopy or a multidisciplinary discussion — not a pH study in isolation.
- Refractory GORD despite PPI
- Barrett’s oesophagus
- Post-fundoplication failure
- Suspected extra-oesophageal reflux
- Post-bariatric reflux
- Concomitant achalasia
- Scleroderma oesophagus
- Dysphagia + weight loss
- Alarm features requiring endoscopic biopsy
Reading your report
A Bravo pH report can look intimidating. It isn’t.
Whatever the finding, the report keeps to the same four parts, benchmarked against DeMeester and Lyon Consensus criteria.
A quiet reminder
The report is written for your doctor, not for you — and that’s normal.
If you would like us to talk you through it before your follow-up, just ask.
- 01 Header
Indication, PPI status and symptoms
Your details, the reason for the study, whether it was on- or off-PPI, and the symptom diary that anchors interpretation.
- 02 Technique
Capsule placement and recording duration
Where the capsule was pinned, the recording length (48 or 96 hours), and any technical caveats.
- 03 Findings
Acid exposure time, DeMeester, SAP and SI
Total and supine acid exposure time, DeMeester composite score, symptom association probability and symptom index.
- 04 Impression
The management recommendation: read this first
Physiological reflux, pathological reflux, functional heartburn or hypersensitivity — with the concrete next step.
Next steps the study directs
Depending on what the numbers show, the report will point to one of these onward paths.
- PPI optimisation
- Lifestyle advice (weight, elevation, timing of meals)
- Alginate or H2-blocker adjunct
- Anti-reflux surgery (fundoplication)
- LINX (magnetic sphincter augmentation)
- TIF endoscopic anti-reflux
- Neurogastroenterology for functional syndromes
- Repeat pH-study monitoring after intervention
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 pH study.
Quick answers on cost, PPI washout, capsule placement, and when the study belongs before anti-reflux surgery.
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What does the Bravo pH study actually change in my management?
It answers three practical questions the endoscopy cannot: is your acid exposure truly pathological, do your symptoms line up with reflux events, and — most decisively — should you be considered for anti-reflux surgery. The answers move you between PPI optimisation, LINX or fundoplication, and the functional-heartburn pathway.
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How is the study different from a 24-hour pH test?
The Bravo is wireless, tolerated much better than a nasal catheter, and records for 48 to 96 hours instead of 24. The longer recording captures day-to-day variability and materially raises the diagnostic yield — particularly when symptoms are intermittent.
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Do I need to stop my PPI beforehand?
For a diagnostic study you stop PPI seven days beforehand. For a refractory-reflux study we deliberately keep you on PPI, to quantify breakthrough acid exposure. Your consultant confirms which approach fits your question.
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How is the capsule placed?
It is pinned to the distal oesophagus during a standard sedated gastroscopy. There is no nasal catheter and no wire — you walk out with a small pager-sized recorder.
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How much does a private Bravo pH study cost in London?
A 48-hour Bravo study, inclusive of the capsule, sedated placement and consultant report, is typically £1,600–£2,400 in our network. Extended 96-hour recording, paired manometry or a management follow-up push the total higher — we quote a firm figure across two or three options.
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When is this study the right test before anti-reflux surgery?
Any patient being considered for LINX or fundoplication should have objective evidence of pathological acid exposure and, ideally, a positive symptom-reflux association. Operating on symptoms alone leads to unhappy patients — the pH study is what separates the two.
Sources
- British Society of Gastroenterology. Guidance on reflux and oesophageal physiology testing.
- American College of Gastroenterology. Clinical guideline: diagnosis and management of GERD.
- Lyon Consensus 2.0 on the diagnosis of reflux disease.
- European Society of Neurogastroenterology and Motility. Position statements on ambulatory reflux monitoring.
Last reviewed 2026-07-30. Next review 2027-07-30. Reading time ~6 min.
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In practice, in London
Booking bravo PH study privately in London — what actually happens
With bravo ph study, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. The wait for bravo PH study on the NHS depends heavily on where you live and how urgently the referral is graded. Central and West London private clinics can normally book within a week, with imaging or a procedure slot to follow shortly after. It’s worth being honest about the reason for going private: usually it’s time, not a fundamentally different test.
Once you’re in the private system for bravo PH study, the pace picks up noticeably. Consultant slots run to time, imaging is usually available in the same building or a short walk away, and the report comes back typed and detailed. It’s the coordination that tends to feel different — one person on the other end of the phone, not a switchboard. For bravo ph study specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
Fit matters more than people expect. For bravo PH study, the right consultant depends on what you actually need — a second opinion, a definitive diagnosis, a bridge into treatment, or reassurance that nothing’s being missed. We match on that, not on who has the biggest brochure. If a test isn’t the right next step, we’ll say so before you book anything.