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From: Peter on 21 Sep 2007 18:38
Howard,

Some of this is new, and some I wrote before, and you might not have got to
it because of my long post (sorry). I will try to keep this short :-) .

I believe the bravo capsule is approx 5.5mm x 6.3mm x 26mm in dimension.
There are 25.4mm per inch for those who might not know, and are interested
in this.

- What is the chance that the capsule, which is about a quarter of an inch
wide by one inch long, won't pass through the pyloric sphincter, and stays
in your stomach after it breaks lose from the esophagus. For it to pass
through the pyloric sphincter it would have to orientate itself just right
longitudinally (so to speak) and it seems that it may not do that all the
time for whatever reason. Am I all wet here. I believe the pyloric
sphincter only opens slightly to allow about an eighth of an ounce of
liquefied food through at a time (per a Mayo article). How will it let this
beast through. Does it open wider when it senses a large object or what - I
wouldn't think so since than it could let large chunks of unliquefied food
through (say that weren't chewed properly). Excuse my ignorance about this.
I am just wondering if the capsule ever gets hung up in the stomach, and you
never excrete it. I think that is a legitimate question. I know people can
excrete rather large objects that remain solid.

- What percentage of people have to go right back and have the capsule
removed because it is just too painful or bothersome for them.

- What do you use for "off therapy" guidance for your 24 hour pH and your 48
hour bravo test patients, ie, how many days off for PPI's, versus H2
blockers, versus Tums. It seems that this varies considerable from doctor
to doctor. A Cleveland clinic article says 7 days, 2 days, and 6 hours
which sounds reasonable. The practice where I am scheduled says 14 days, 5
days, and 1 day, which I consider way too conservative.

Thanks Howard...Pete


From: Howard McCollister on 22 Sep 2007 01:21
In article <fd1h4f02e05(a)enews1.newsguy.com>, "Peter" <peter(a)nospam.net>
wrote:

> Howard,
>
> Some of this is new, and some I wrote before, and you might not have got to
> it because of my long post (sorry). I will try to keep this short :-) .
>
> I believe the bravo capsule is approx 5.5mm x 6.3mm x 26mm in dimension.
> There are 25.4mm per inch for those who might not know, and are interested
> in this.
>
> - What is the chance that the capsule, which is about a quarter of an inch
> wide by one inch long, won't pass through the pyloric sphincter, and stays
> in your stomach after it breaks lose from the esophagus. For it to pass
> through the pyloric sphincter it would have to orientate itself just right
> longitudinally (so to speak) and it seems that it may not do that all the
> time for whatever reason. Am I all wet here. I believe the pyloric
> sphincter only opens slightly to allow about an eighth of an ounce of
> liquefied food through at a time (per a Mayo article). How will it let this
> beast through. Does it open wider when it senses a large object or what - I
> wouldn't think so since than it could let large chunks of unliquefied food
> through (say that weren't chewed properly). Excuse my ignorance about this.
> I am just wondering if the capsule ever gets hung up in the stomach, and you
> never excrete it. I think that is a legitimate question. I know people can
> excrete rather large objects that remain solid.
>
> - What percentage of people have to go right back and have the capsule
> removed because it is just too painful or bothersome for them.
>
> - What do you use for "off therapy" guidance for your 24 hour pH and your 48
> hour bravo test patients, ie, how many days off for PPI's, versus H2
> blockers, versus Tums. It seems that this varies considerable from doctor
> to doctor. A Cleveland clinic article says 7 days, 2 days, and 6 hours
> which sounds reasonable. The practice where I am scheduled says 14 days, 5
> days, and 1 day, which I consider way too conservative.
>
> Thanks Howard...Pete

In the thousand or so Bravo's we've done, I've never heard of a capsule
getting stuck. I'd say the chance of that is about as close to zero as
you can get. The video capsules we use for capsule endoscopy are
substantially larger than a Bravo capsule - the only one I've ever seen
stuck was in a patient with Crohn's disease where it hung up in a
stricture at the last part of the small intestine.

With a Bravo capsule attached, some people notice a tugging sensation
while swallowing. Pain is extremely rare. I've never had to remove
one...neither have any of my partners.

We recommend 5 days off for PPIs, 3 days for H2 blockers, and we ignore
antacids, just make sure the patient documents when they take them.

HMc
From: Peter on 22 Sep 2007 13:17
Howard McCollister wrote:
> In article <fd1h4f02e05(a)enews1.newsguy.com>, "Peter"
> <peter(a)nospam.net> wrote:
>
>> Howard,
>>
>> Some of this is new, and some I wrote before, and you might not have
>> got to it because of my long post (sorry). I will try to keep this
>> short :-) .
>>
>> I believe the bravo capsule is approx 5.5mm x 6.3mm x 26mm in
>> dimension. There are 25.4mm per inch for those who might not know,
>> and are interested in this.
>>
>> - What is the chance that the capsule, which is about a quarter of
>> an inch wide by one inch long, won't pass through the pyloric
>> sphincter, and stays in your stomach after it breaks lose from the
>> esophagus. For it to pass through the pyloric sphincter it would
>> have to orientate itself just right longitudinally (so to speak) and
>> it seems that it may not do that all the time for whatever reason.
>> Am I all wet here. I believe the pyloric sphincter only opens
>> slightly to allow about an eighth of an ounce of liquefied food
>> through at a time (per a Mayo article). How will it let this beast
>> through. Does it open wider when it senses a large object or what -
>> I wouldn't think so since than it could let large chunks of
>> unliquefied food through (say that weren't chewed properly). Excuse
>> my ignorance about this. I am just wondering if the capsule ever
>> gets hung up in the stomach, and you never excrete it. I think that
>> is a legitimate question. I know people can excrete rather large
>> objects that remain solid.
>>
>> - What percentage of people have to go right back and have the
>> capsule removed because it is just too painful or bothersome for
>> them.
>>
>> - What do you use for "off therapy" guidance for your 24 hour pH and
>> your 48 hour bravo test patients, ie, how many days off for PPI's,
>> versus H2 blockers, versus Tums. It seems that this varies
>> considerable from doctor to doctor. A Cleveland clinic article says
>> 7 days, 2 days, and 6 hours which sounds reasonable. The practice
>> where I am scheduled says 14 days, 5 days, and 1 day, which I
>> consider way too conservative.
>>
>> Thanks Howard...Pete
>
> In the thousand or so Bravo's we've done, I've never heard of a
> capsule getting stuck. I'd say the chance of that is about as close
> to zero as you can get. The video capsules we use for capsule
> endoscopy are substantially larger than a Bravo capsule - the only
> one I've ever seen stuck was in a patient with Crohn's disease where
> it hung up in a stricture at the last part of the small intestine.
>
> With a Bravo capsule attached, some people notice a tugging sensation
> while swallowing. Pain is extremely rare. I've never had to remove
> one...neither have any of my partners.
>
> We recommend 5 days off for PPIs, 3 days for H2 blockers, and we
> ignore antacids, just make sure the patient documents when they take
> them.
>
> HMc

Thank you Howard...Pete


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