It is now 30 years since effective antisecretory drugs in the form of H₂ receptor antagonists became available for use in clinical practice. Since then the use of medications which elevate intragastric pH has progressively increased and a significant proportion of the population is taking powerful antisecretory medication on a long term basis. In view of the recognised association between hypochlorhydria and gastric cancer,^1,2 there has been concern that long term use of acid suppressive medication might increase the risk of this sinister condition. In this issue of Gut, García Rodríguez and colleagues³ report the association between long term antisecretory medication and upper gastrointestinal cancer (see page 1538).

The study used the UK general practitioners research database (GPRD) which is a primary care automated database initiated in the late 1980s and currently including more then 3 million subjects. It contains detailed information on patient demographics, diagnosis, and drug prescriptions. The information is automatically transferred from the general practitioner’s computer to the database. The current study was based on a cohort of all individuals registered on the GPRD aged 40–84 years during the period January 1994 to December 2001. Over the 4 340 207 person years of follow up, 287 oesophageal adenocarcinoma, 195 gastric cardia adenocarcinoma, and 327 gastric non-cardia adenocarcinoma were diagnosed. Patients who developed upper gastrointestinal cancers during the study …