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Enterogastric Bile Reflux during Technetium-99m-Sestamibi Cardiac Imaging

Departments of Radiology, Cardiology and Division of Gastroenterology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin

Correspondence: For correspondence or reprints contact: B. David Collier, MD, Doyne Clinic-DH-104, 8700 W. Wisconsin Ave., Milwaukee, WI 53226.

ABSTRACT

Enterogastric bile reflux (EGBR), a risk factor for both gastritis and esophagitis, is a potentially treatable noncoronary cause for chest pain. Methods: To investigate the frequency of EGBR during different ^99mTc-sestamibi cardiac imaging, 1405 consecutive ^99mTc-sestamibi SPECT myocardial perfusion studies were reviewed. Results: One hundred sixteen of the 1405 patient studies (8.3%) showed EGBR with roughly equal numbers of patients having marked (43 patients), moderate (38 patients) or minimal (35 patients) intensity of abnormal gastric activity. Two examinations showed gastroesophageal reflux of activity. EGBR was less frequent with treadmill stress testing (5.5% patients) than with pharmacologic stress testing using either dipyridamole (11% of patients) or dobutamine (9.2% of patients) (p > 0.005). EGBR also was more frequent in patients over 40 yr of age. Finally, the prevalence of upper gastrointestinal symptoms and the frequency of established upper gastrointestinal diagnoses correlated strongly with the presence and intensity of EGBR. Conclusion: Clarification of the full clinical significance of EGBR during ^99mTc-sestamibi cardiac imaging is a topic for future research. Nonetheless, the imaging finding of EGBR may, in fact, identify a potentially treatable noncoronary cause for chest pain.

Key Words: technetium-99m-sestamibi • cardiac abnormalities • esophagitis • gastritis • SPECT • myocardial imaging

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