• dyspepsia
• oesophagogastric cancer
• age
• endoscopy

Wallace et al (Gut 2001;49:29–34) clearly describe the difficulties with AGA guidelines for endoscopy in the light of their study in identifying young oesophagogastric pathology. They concluded that better clinical prediction strategies are needed. In the UK we have found similar failings in our own guidelines for endoscopy¹ for identification of young patients with oesophagogastric carcinoma. The national data suggesting oesophagogastric carcinoma is rare in patients under 55 years seemed at odds with the large number of patients we had seen in this age group in recent years.

We reviewed our oesophagogastric cancers over three years and found 76 patients under the age of 55 years between January 1997 and December 1999. The hospital records of these patients were examined with the general practice records where possible. A detailed review was undertaken in patients under 50 years old, looking at their presenting symptoms, stage, location, nature, and size of tumour. Timings were noted from the date symptoms first developed, referral date, date of diagnosis, and date of death. Kaplan-Meier methods were used to estimate survival.

Of the 460 patients …