Editor,—Bramble et al 1 have recently suggested that the long recognised lack of impact of open access gastroscopy on the detection of earlier upper GI cancer2 ,3 may be due in part to the masking of cancer by prior acid suppressive therapy. This is based on a higher rate of undiagnosed cancer at index gastroscopy in their group of patients who had received acid suppressive therapy within the six months before that gastroscopy. They conclude that clinical guidelines and endoscopy waiting times should take account of this. However, there are some serious flaws in their case series which preclude the drawing of such conclusions.

Firstly, their study is retrospective. Without prospective randomisation, one cannot ensure that their two groups are comparable. The patients who were not prescribed antisecretory therapy are more likely to have had symptoms or signs suggesting underlying cancer. Because such symptoms occur in …