association of use of proton pump inhibitors and h 2 antagonists with stomach wall uptake in 99m tc-methoxy-isobutyl-isonitrile (mibi) myocardial perfusion imaging

Stomach wall uptake (swu) of tracer in 99mtc-mibi myocardial perfusion imaging (mpi) occasionally leads to imaging artifacts, thereby lowering the diagnostic accuracy. it is less-studied phenomenon for possible link with proton pump inhibitors (ppis) intake. this prospective work looked for association of swu with ppi intake and compared its incidence with h2 antagonists (h2a) users and patients not on either gastroprotective medication. one hundred fifty-six patients undergoing one day stress/rest 99mtc-mibi spect-mpi were distributed into four groups: control group (n = 48, not on any gastroprotective medication), ppi group (n = 47, on ppi treatment), h2a group (n = 19, on h2a therapy), and intervention group (n = 42, ppi discontinued for 3 days before mpi). poststress planar images were analyzed for clinically relevant swu. clinically relevant swu was seen in 36% of ppi group patients compared to 8% in the control group, 10.5% in the h2a group, and 9.5% in the intervention group, respectively, with statistically significant difference. only 1/40 patients undergoing exercise stress showed clinically relevant swu compared to 26/116 patients undergoing adenosine stress (p = .020). patients on ppis scheduled for vasodilator stress mpi discontinue ppis for 3 days, or replace with h2a to reduce the incidence of clinically relevant swu associated with ppi therapy.