Dyspeptic patients over 45 should undergo endoscopy before these drugs are started

Gastric cancer is still widely regarded as an incurable condition in the West. However, this nihilistic approach is no longer tenable as this cancer is eminently curable if it is diagnosed and treated at an early stage.1 The five year survival of patients undergoing appropriate surgery for early gastric cancer is greater than 90%. Screening of the asymptomatic population, such as occurs in Japan, would not be feasible or cost effective in Western countries, so early diagnosis has to rely on symptomatic patients presenting to their general practitioners, who then recognise the importance of the symptoms and refer them for endoscopy. Since the early symptoms are often indistinguishable from those of benign ulcer disease, the inappropriate use of powerful antiulcer drugs has had the effect of masking the true diagnosis in some cases.

A significant proportion of patients with early gastric cancer do experience symptoms and in most these are typical dyspeptic symptoms.2 For this reason …