A Mucosa-Interfacing Wireless pH-Impedance Monitoring System for Continuous Reflux Monitoring to Prevent Barrett’s Esophagus and Esophageal Adenocarcinoma

Gastroesophageal reflux disease (GERD) is a major risk factor for Barrett’s esophagus and esophageal adenocarcinoma, the most common type of esophageal cancer in the US. Early identification of injurious reflux patterns is critical for cancer prevention, yet current diagnostic tools are inadequate. The 24-hour pH–impedance catheter accurately detects acid and non-acid reflux but is uncomfortable and unsuitable for prolonged monitoring, while the Bravo™ capsule enables catheter-free wireless monitoring but detects only acid reflux and relies on mechanical clip fixation, which can cause mucosal injury. Importantly, growing evidence shows that weakly acidic and non-acid reflux, often containing bile salts or pepsin, drives chronic mucosal inflammation and metaplastic progression, even in patients receiving proton pump inhibitor therapy. We propose a catheter-free, mucosa-interfacing reflux monitoring system that enables prolonged, comfortable detection of both acid and non-acid reflux. We hypothesize that integrating a reversible electroadhesive hydrogel interface with wireless dual pH–impedance sensing will allow stable, atraumatic attachment to the esophageal mucosa for multi-day monitoring, followed by safe, on-demand detachment without tissue injury. This proposal comprises two specific aims. Aim 1 will optimize electrical stimulation parameters and hydrogel geometries to achieve strong (>500 J/m², comparable to tendon–bone interfaces), stable, and fully reversible electroadhesion to esophageal mucosa while preserving tissue integrity. Aim 2 will integrate the optimized electroadhesive interface with a miniaturized wireless pH–impedance sensing capsule and evaluate retention longevity, sensing fidelity, wireless data transmission, and atraumatic detachment in a clinically relevant porcine model. This R21 will establish feasibility and generate critical preliminary data to support future R01-level studies. Cancer Relevance: By enabling longitudinal, site-specific monitoring of injurious reflux exposure, this technology supports early interception of Barrett’s esophagus and prevention of esophageal adenocarcinoma through improved risk assessment and timely intervention.