Effect of PPI use on the diagnosis of biliary dyskinesia with CCK HIDA scintigraphy

Wesley A Dailey, MD, Steven Bowers, MD, John A Stauffer, MD, Horacio J Asbun, MD, Mauricia A Buchanan, RN, Eric Lam, BS. Mayo Clinic Florida.

Background: A previous small study on healthy subjects demonstrated that proton pump inhibitors (PPIs) were associated with a significant reduction in gall bladder ejection fraction (GBEF). It has been a widely accepted belief in medical circles that PPI therapy interferes with hepatobiliary scintigraphy (HIDA) scan results, presumably due to the similar structure of cholecystokinin (CCK) and gastrin, given the known increase in gastrin levels amongst patients taking PPIs. We sought to determine if the use of PPI medications was associated with a reduction in gallbladder ejection fraction in patients undergoing CCK-stimulated HIDA scan for evaluation of biliary dyskinesia.

Methods: At a tertiary care center 366 patients underwent HIDA exams from 2008 to 2012; 93 patients had CCK given at the time of HIDA in order to measure GBEF for the purpose of identifying biliary dyskinesia. Demographic and clinical data of patients on PPI (N=31) were compared to those not on PPI (n=62). These two groups were well matched demographically [female (77% vs 71%, NS), age (53 vs. 53, NS), BMI (27.2 vs 26.5, NS)] and had similar clinical presentation [abdominal pain (87% vs. 81%, NS), nausea (19% vs. 31%, NS), bloating (13% vs. 7%, NS), vomiting (10% vs. 15%, NS), meal related symptoms (26% vs. 18%, NS)]. CCK HIDA exam findings were compared between groups in terms of mean GBEF and frequency of abnormal exam (GBEF < 35%). Continuous variables were assessed for significance by t test and categorical variables were assessed by a Fisher’s exact test.

Results: The PPI and non PPI groups had similar mean GBEF (57.7% vs. 64.7% respectively, p=0.14). The groups also had a similar frequency of abnormal CCK HIDA exams (29.0% vs. 16.1% respectively, p=0.12).

Conclusions: This study demonstrates that use of PPI medications has no significant or clinically relevant effect on the outcome of a CCK-stimulated HIDA scan in the diagnosis of biliary dyskinesia.

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