Background: Absent gastric bubble was an X-ray chest finding preoperatively of a 68 year old gentleman posted for CABG. Apart from symptoms of unstable angina consistent with his angiographic findings, he complained of chest pain at night and lump in throat which we could attribute to gastroesophageal reflux disease. The aim of this study was to find the causes of absent gastric air bubble, so as to understand its implications and prevent the possible complications in patients undergoing CABG.

Methods: All patients undergoing cardiac surgery underwent prescribed blood investigation, ECG, X-ray chest (PAview ) PFT, carotid doppler, 2D ECHO and coronary angiography. Over a period of 6 months we had 5 patients whose X-ray chest showed absent gastric air bubble. All of the 5 patients were evaluated and managed preoperative,intra and postoperative keeping in mind the possible complications.

Results: Cause of absent gastric bubble in our patients: 1. Hiatus hernia -1 2. Achalesia cardia -1 3. Gastro-esophegael reflux disease -3 Conclusion: Absent gastric bubble is a sign which needs to be investigated pre-operatively for its cause. Gastro-esophageal reflux disease is a common disease which mimics heart attack.1. and is common in patients coming for CABG and can be a cause for concern for patient due to persistent chest pain post surgery. Adequate precautions like duration of fasting preop-operatively, prevention of micro aspiration post-operatively with head end elevation and low fat diet, abstinence from smoking, tea, coffee intake, weightloss will help in relieving symptoms of GERD and improve patient satisfaction post CABG. Confirmation and explanation of the observed relation between the presence of hiatal hernia and infarction requires further research .