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Evidence does not exist that dyspepsia heralds gastric cancer in its earliest stage

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7193.1288 (Published 08 May 1999) Cite this as: BMJ 1999;318:1288
  1. Thomas S Low-Beer, Consultant physician (t.s.low-beer{at}bham.ac.uk)
  1. 38 Weoley Park Road, Birmingham B29 6RB

    EDITOR—The editorial claiming that proton pump inhibitors may mask early gastric cancer recommends that “dyspeptic patients over 45 should undergo endoscopy before these drugs are started.”1 The authors argue that this policy is justified by the improved curability of gastric cancer diagnosed at an early stage. They quote the studies by Hallissey et al and Fielding et al, which show an increased proportion of gastric cancers diagnosed at an early stage when all dyspeptic patients aged over 40 are invited to undergo gastroscopy. 2 3 No control group of otherwise matched non-dyspeptic patients was studied. These results therefore do little more than show that as a population undergoes increased gastroscopy so gastric cancer presents earlier, rather than that dyspepsia is a useful symptom heralding gastric cancer in its earliest stage.

    There may be good reasons for carrying out endoscopy for all patients over 45 with onset of dyspepsia before treating them with an acid suppressant; evidence does not yet exist, however, to show that the ability to diagnose gastric cancer early is one of them.

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