Detection of upper gastrointestinal cancer in patients taking antisecretory therapy prior to gastroscopy

Background-The incidence of early gastric cancer has not increased despite better access to endoscopic facilities for general practitioners. Many pati ents receive a course of symptomatic treatment while waiting for gastroscop y. Aims-To ascertain the effect of antisecretory therapy on the diagnostic pro cess and findings for patients with upper gastrointestinal cancer. Methods-A consecutive case study survey of the primary care records of 133 patients who had died of upper gastrointestinal cancer during 1995-97 in th e South Tees health district in the northeast of England (population 300 00 0). Results-From the 133 patients identified, 116 had died from adenocarcinoma of the oesophagus (31) or stomach (85). Failure to reach the diagnosis of c ancer at the index gastroscopy was associated with prior acid suppression t herapy. Only one of 54 patients on no treatment or antacids alone was erron eously diagnosed as suffering from benign disease, whereas 22 of 62 patient s treated with acid suppression were diagnosed as suffering from benign dis ease but at varying times later turned out to have adenocarcinoma. Twenty o f 45 patients taking a proton pump inhibitor had a delayed diagnosis compar ed with two of 17 taking an H-2 receptor antagonist. The commonest lesion s een at index gastroscopy in those in whom the diagnosis was initially misse d was gastric ulcer. Healing occurred in six patients taking a proton pump inhibitor, despite their later diagnosis of malignancy. Conclusions-The treatment of dyspeptic symptoms with acid suppression prior to gastroscopy masks and delays the detection of gastric and oesophageal a denocarcinoma on endoscopy in one third of patients.