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Discussion I

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Question: Professor Tytgat, you mentioned a study from the UK in which patients with gastric cancer had previously undergone endoscopy but in whom an early lesion was missed. Which study was this and where was it published?

Professor Tytgat: The study was published in Gut in 1997.1 The study looked at a large group of patients with gastric cancer. Approximately 70% of these patients had peptic symptoms prior to the diagnosis of early malignancy, and a substantial proportion of these had undergone endoscopy prior to detecting overt malignancy. Undoubtedly, at the time of endoscopy, the lesion must have been present. This is the very first paper to indicate that we probably miss a lot on endoscopy—at least that is the message that I took from the paper.

Question: Why were the early malignancies missed? Could it be due to the fact that not enough biopsies were taken?

Professor Tytgat: These early malignancies are tiny abnormalities, just tiny discolourations or elevations, and perhaps we should be looking for these instead, particularly in patients over the age of 45–50 years.

Question: How long should a patient be off antisecretory or antiulcer medication before he/she can be considered to have a normal endoscopy?

Professor Tytgat: I do not think that we know the answer to that one yet.

Professor Dent: In the case of gastro-oesophageal reflux disease (GORD), follow up studies suggest that it can take at least three months for the majority of patients to show endoscopic relapse, which I find a bit surprising. I am also not sure we really know the answer.

Professor Talley: The Rome Committee struggled with this issue in the absence of any good data.2 In fact, this is an area for clinical research for anyone who might be interested in a new project. It …

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