Prescription of proton pump inhibitors before endoscopy - A potential cause of missed diagnosis of early gastric cancers

Background: Early gastric cancer is frequently seen with nonspecific dyspep tic symptoms and subtle endoscopic features. Treatment at this stage of the disease produces a high chance of cure. If the diagnosis is missed at this early stage, then the prognosis may be much poorer depending on the subseq uent delay in reaching a diagnosis. Objectives: To report the healing effect of proton pump inhibitors on early gastric cancer. Methods: This article reports a case series of 7 patients with ulcerated ea rly gastric cancers indistinguishable as malignant gastric ulcers at endosc opy who were inadvertently prescribed a short course of a proton pump inhib itor prior to a second confirmatory endoscopy. The cases studied were patie nts with dyspeptic symp toms referred from primary care physicians for uppe r gastrointestinal endoscopy. Results: In each case the patient became asymptomatic, the endoscopic signs seen at the first endoscopy had resolved, and the lesions could not be rec ognized even by an experienced endoscopist. If the proton pump inhibitors h ad been prescribed by the referring physician before the first endoscopy, t he diagnosis probably would have been missed. These cases demonstrate the p otentially serious masking effect of prescribing a short course of these dr ugs before making an endoscopic diagnosis. Even though the patient has been referred for endoscopy, the endoscopist may fail to identify the lesion an d thus miss the diagnosis. Conclusions: Primary care physicians must resist the pressures to prescribe proton pump inhibitors before endoscopy, particularly in patients older th an 45 years, if the diagnostic yield of gastric cancer in the early curable stages is to be maximized.