Effect of proton pump inhibitors and H2 antagonists on gastric wall uptake in myocardial perfusion scan with 99mTc-sestamibi

Abstract

Background

Proton pump inhibitors (PPIs) have been speculated to cause gastric wall uptake (GWU) in MPI scans. However, the uptake mechanism and prevention methods are less studied. In this prospective trial we aimed to evaluate the impact of gastroprotective medications on GWU and its solutions.

Methods

351 consecutive patients, scheduled for 2-day rest/stress 99mTc-MIBI scan, were distributed into 5 groups. 3-7 days following the baseline rest scan, the stress scan was acquired after intervention in the trial group, consisting of patients with history of PPI intake, randomly assigned to 3 subgroups: discontinuing PPIs(A), replacement with H2 blockers (B), and continuing PPIs (C). Patients receiving H2 blockers, continued it as before (D) and the remaining patients were the control group (E). GWU was graded compared to the myocardial uptake.

Results

In the rest phase, all groups had significantly higher GWU compared to the control group. In the stress phase, group A had less GWU than group B (P-value < 0.05) and both of them had significantly less GWU compared to group C (P-value < 0.001). There was no significant difference between PPI discontinuation periods of 3-5 days versus 5-7 days. There was a significant association between duration of oral PPI intake, but not IV PPIs, and GWU. GWU was significantly lower with oral compared to IV PPI administration.

Conclusion

PPIs significantly increase GWU and discontinuing them for at least 3-5 days significantly reduces GWU. H2 antagonists are a good alternative in patients who cannot tolerate dyspepsia symptoms.

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Abbreviations

GWU:

Gastric wall uptake

PPI:

Proton pump inhibitor

MPI:

Myocardial perfusion imaging

IV:

Intravenous

GPM:

Gastro-protective medication

CAD:

Coronary artery disease

99mTc-MIBI:

Technetium-99m methoxy-isobutyl-isonitrile

SPECT:

Single-Photon Emission Computed Tomography

PUD:

Peptic ulcer disease

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Correspondence to Elahe Pirayesh.

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Disclosures

This study was supported in part by research grants from clinical research and development unit of Shohada-e Tajrish medical center (toElahePirayesh). Ghazal Norouzi and AzinAsadZadeh have nothing to disclose.

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Norouzi, G., AsadZade, A., Salimi, Y. et al. Effect of proton pump inhibitors and H2 antagonists on gastric wall uptake in myocardial perfusion scan with 99mTc-sestamibi. J. Nucl. Cardiol. (2021). https://doi.org/10.1007/s12350-021-02529-6

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Keywords

  • SPECT
  • myocardial perfusion imaging
  • 99mTc-MIBI
  • proton pump inhibitor
  • H2 antagonist
  • gastric wall uptake