Editor,—We read with interest the study by Suvakovic et al (Gut1997;41:308–13) reporting that 63% of the patients with early gastric cancer had a previous history of upper gastrointestinal symptoms. These authors concluded that guidelines for the appropriateness of gastroscopy in patients with dyspepsia need to reflect the importance of not starting treatment prior to gastroscopy. General practitioners need to be made more aware of the potential for antisecretory drugs to mask early gastric cancer, which will then have a major detrimental impact on patient management. We have also studied whether patients with gastric cancer had serious and persistent dyspeptic symptoms necessitating consultation with their general practitioner (Laheij et al, unpublished observations). The results of our study, however, differ from Suvakovic et al’s.

We identified 46 patients with diagnostically verified early and late stage gastric cancer, using the Continuous Morbidity Register. This database is …