Association of use of proton pump inhibitors and H2 antagonists with stomach wall uptake in 99mTc-methoxy-isobutyl-isonitrile (MIBI) myocardial perfusion imaging

Background Stomach wall uptake (SWU) of tracer in Tc-99m-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 H-2 antagonists (H(2)A) users and patients not on either gastroprotective medication. Methods One hundred fifty-six patients undergoing one day stress/rest Tc-99m-MIBI SPECT-MPI were distributed into four groups: control group (n = 48, not on any gastroprotective medication), PPI group (n = 47, on PPI treatment), H(2)A group (n = 19, on H(2)A therapy), and intervention group (N = 42, PPI discontinued for 3 days before MPI). Poststress planar images were analyzed for clinically relevant SWU. Results Clinically relevant SWU was seen in 36% of PPI group patients compared to 8% in the control group, 10.5% in the H(2)A 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). Conclusion Patients on PPIs scheduled for vasodilator stress MPI may discontinue PPIs for 3 days, or replace with H(2)A to reduce the incidence of clinically relevant SWU associated with PPI therapy.