Acid suppression and upper GI cancer diagnosis [Letters to the editor] [Letters to the editor]
Identifieur interne : 000382 ( Istex/Corpus ); précédent : 000381; suivant : 000383Acid suppression and upper GI cancer diagnosis [Letters to the editor] [Letters to the editor]
Auteurs : Derek Gillen ; Kenneth E L. Mccoll ; M G Bramble ; Z. Suvakovic ; A P S. HunginSource :
- Gut [ 0017-5749 ] ; 2000-11-01.
Url:
DOI: 10.1136/gut.47.5.740a
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ISTEX:DF8E15259297E80BFE5B5A532F16AA139F36C69BLe document en format XML
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xlink:type="simple"><name name-style="western"><surname>McCOLL</surname><given-names>KENNETH E L</given-names></name></contrib></contrib-group><aff id="aff1">Division of Gastroenterology</aff><aff id="aff2">Department of Medicine & Therapeutics</aff><aff id="aff3">University of Glasgow</aff><aff id="aff4">Western Infirmary</aff><aff id="aff5">Glasgow G11 6NT</aff><aff id="aff6"><email xlink:type="simple">K.E.L.McColl@clinmed.gla.ac.uk</email></aff><pub-date pub-type="ppub"><day>1</day><month>11</month><year>2000</year></pub-date><pub-date pub-type="epub"><day>1</day><month>11</month><year>2000</year></pub-date><volume>47</volume><volume-id pub-id-type="other">47</volume-id><volume-id pub-id-type="other">47</volume-id><issue>5</issue><issue-id pub-id-type="other">gutjnl;47/5</issue-id><issue-id pub-id-type="other">5</issue-id><issue-id pub-id-type="other">47/5</issue-id><fpage seq="2">740</fpage><permissions><copyright-statement>British Society of Gastroenterology</copyright-statement><copyright-year>2000</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="gutjnl-47-740-2.pdf"></self-uri></article-meta></front><response response-type="reply" xml:lang="EN"><front><journal-meta><journal-id journal-id-type="hwp">gutjnl</journal-id><journal-id journal-id-type="nlm-ta">Gut</journal-id><journal-id journal-id-type="publisher-id">gut</journal-id><journal-title>Gut</journal-title><abbrev-journal-title abbrev-type="publisher">Gut</abbrev-journal-title><abbrev-journal-title>Gut</abbrev-journal-title><issn pub-type="ppub">0017-5749</issn><issn pub-type="epub">1468-3288</issn><publisher><publisher-name>BMJ Publishing Group Ltd and British Society of Gastroenterology</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="other">response1</article-id><article-categories><subj-group subj-group-type="heading"><subject>Letters to the editor</subject></subj-group></article-categories><title-group><article-title>Reply</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>BRAMBLE</surname><given-names>M G</given-names></name></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>SUVAKOVIC</surname><given-names>Z</given-names></name></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>HUNGIN</surname><given-names>A P S</given-names></name></contrib></contrib-group><aff id="aff7">Centre for Health Studies</aff><aff id="aff8">University of Durham</aff><aff id="aff9">32 Old Elvet</aff><aff id="aff10">Durham DH1 3HN</aff><aff id="aff11"><email xlink:type="simple">C.H.S.Office@durham.ac.uk</email></aff><pub-date pub-type="ppub"><day>1</day><month>11</month><year>2000</year></pub-date><pub-date pub-type="epub"><day>1</day><month>11</month><year>2000</year></pub-date><volume>47</volume><volume-id pub-id-type="other">47</volume-id><issue>5</issue><issue-id pub-id-type="other">5</issue-id><fpage seq="2">740</fpage><permissions><copyright-statement>British Society of Gastroenterology</copyright-statement><copyright-year>2000</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="gutjnl-47-740-2.pdf"></self-uri></article-meta></front><body><p>Gillen and McColl correctly point out the problems of a retrospective study and we do state in the article that we were unsure as to why some patients had been prescribed antisecretory therapy while others had not. We feel it might be difficult to justify a prospective study on ethical grounds when the consequences of missing just one cancer would be enormous in the context of a clinical trial, not to mention any medicolegal implications. To a large extent, the argument about advanced cancer patients having different symptoms is irrelevant if patients with ulcer like symptoms are being missed when the diagnosis is really “ulcer cancer”. As Gillen and McColl suggest, these patients are less likely to have advanced disease but surely this is precisely the group we should be diagnosing as early as possible (and hence at the first gastroscopy). If “symptomatic treatment” turns out to be healing treatment, masking the true diagnosis, this is a cause for serious concern. The extent to which proton pump inhibitors might do this is even more worrying.</p><p>With regard to their second point, there is ample evidence in the literature that the stage at which gastric cancer is diagnosed affects five year survival and very early disease is curable.<xref rid="B1-1" ref-type="bibr">1-1</xref> In our health district the vast majority of gastric cancers are beyond stage II, and the point of our paper was to highlight the fact that a significant number of patients had previously been investigated and told they had benign disease. The patients reasonably expect that their prognosis would have been better if they had been diagnosed six months or one year earlier. As 87% of our patients do not have early stage disease<xref rid="B1-2" ref-type="bibr">1-2</xref> and the authors do not operate on patients, the outcome of surgery was not the prime focus of the paper. We know that very few will be cured by surgery. The only effective way of improving outcome is to diagnose the condition earlier and the crucial question is whether this is achievable in the UK.</p><p>Finally, we are not proposing any changes which would have “huge resource implications” or result in “major changes in clinical practice”. Our message is that proton pump inhibitors should not be prescribed to patients with dyspepsia over the age of 45 years without a gastroscopy. It follows, therefore, that patients should not have to wait an unnecessarily long time for this simple investigation. Is a randomised, controlled trial really needed to confirm that this is good clinical practice?</p></body><back><ref-list><ref id="B1-1"><label>1-1</label><citation citation-type="journal" xlink:type="simple"><person-group person-group-type="author"><name name-style="western"><surname>Sue-Ling</surname><given-names>HM</given-names></name><name name-style="western"><surname>Johnson</surname><given-names>D</given-names></name><name name-style="western"><surname>Martin</surname><given-names>IG</given-names></name><etal></etal></person-group> (<year>1993</year>) <article-title>Gastric cancer: a curable disease in Britain.</article-title> <source>BMJ</source> <volume>307</volume>:<fpage>591</fpage>–<lpage>596</lpage>.</citation></ref><ref id="B1-2"><label>1-2</label><citation citation-type="journal" xlink:type="simple"><person-group person-group-type="author"><name name-style="western"><surname>Suvakovic</surname><given-names>Z</given-names></name><name name-style="western"><surname>Bramble</surname><given-names>MG</given-names></name><name name-style="western"><surname>Jones</surname><given-names>R</given-names></name><etal></etal></person-group> (<year>1997</year>) <article-title>Improving the detection rate of early gastric cancer requires more than open access gastroscopy. A five year study.</article-title> <source>Gut</source> <volume>41</volume>:<fpage>308</fpage>–<lpage>313</lpage>.</citation></ref></ref-list></back></response></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Acid suppression and upper GI cancer diagnosis [Letters to the editor] [Letters to the editor]</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Acid suppression and upper GI cancer diagnosis [Letters to the editor] [Letters to the editor]</title></titleInfo><name type="personal"><namePart type="given">DEREK</namePart><namePart type="family">GILLEN</namePart><affiliation>Division of Gastroenterology</affiliation><affiliation>Department of Medicine & Therapeutics</affiliation><affiliation>University of Glasgow</affiliation><affiliation>Western Infirmary</affiliation><affiliation>Glasgow G11 6NT</affiliation><affiliation></affiliation><affiliation>E-mail: K.E.L.McColl@clinmed.gla.ac.uk</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">KENNETH E L</namePart><namePart type="family">McCOLL</namePart><affiliation>Division of Gastroenterology</affiliation><affiliation>Department of Medicine & Therapeutics</affiliation><affiliation>University of Glasgow</affiliation><affiliation>Western Infirmary</affiliation><affiliation>Glasgow G11 6NT</affiliation><affiliation></affiliation><affiliation>E-mail: K.E.L.McColl@clinmed.gla.ac.uk</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">M G</namePart><namePart type="family">BRAMBLE</namePart><affiliation>Division of Gastroenterology</affiliation><affiliation>Department of Medicine & Therapeutics</affiliation><affiliation>University of Glasgow</affiliation><affiliation>Western Infirmary</affiliation><affiliation>Glasgow G11 6NT</affiliation><affiliation></affiliation><affiliation>E-mail: K.E.L.McColl@clinmed.gla.ac.uk</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Z</namePart><namePart type="family">SUVAKOVIC</namePart><affiliation>Division of Gastroenterology</affiliation><affiliation>Department of Medicine & Therapeutics</affiliation><affiliation>University of Glasgow</affiliation><affiliation>Western Infirmary</affiliation><affiliation>Glasgow G11 6NT</affiliation><affiliation></affiliation><affiliation>E-mail: K.E.L.McColl@clinmed.gla.ac.uk</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A P S</namePart><namePart type="family">HUNGIN</namePart><affiliation>Division of Gastroenterology</affiliation><affiliation>Department of Medicine & Therapeutics</affiliation><affiliation>University of Glasgow</affiliation><affiliation>Western 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