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Prescription of Proton Pump Inhibitors Before Endoscopy
A Potential Cause of Missed Diagnosis of Early Gastric Cancers
John Wayman, MB, FRCS;
Nick Hayes, MB, FRCS;
Simon A. Raimes, MD, FRCS;
S. Michael Griffin, MD, FRCS
Arch Fam Med. 2000;9:385-388.
Background Early gastric cancer is frequently seen with nonspecific dyspeptic symptoms and subtle endoscopic features. Treatment at this stage of the disease produces a high chance of cure. If the diagnosis is missed at this early stage, then the prognosis may be much poorer depending on the subsequent delay in reaching a diagnosis.
Objectives To report the healing effect of proton pump inhibitors on early gastric cancer.
Methods This article reports a case series of 7 patients with ulcerated early gastric cancers indistinguishable as malignant gastric ulcers at endoscopy who were inadvertently prescribed a short course of a proton pump inhibitor prior to a second confirmatory endoscopy. The cases studied were patients with dyspeptic symptoms referred from primary care physicians for upper gastrointestinal endoscopy.
Results In each case the patient became asymptomatic, the endoscopic signs seen at the first endoscopy had resolved, and the lesions could not be recognized even by an experienced endoscopist. If the proton pump inhibitors had been prescribed by the referring physician before the first endoscopy, the diagnosis probably would have been missed. These cases demonstrate the potentially serious masking effect of prescribing a short course of these drugs before making an endoscopic diagnosis. Even though the patient has been referred for endoscopy, the endoscopist may fail to identify the lesion and thus miss the diagnosis.
Conclusions Primary care physicians must resist the pressures to prescribe proton pump inhibitors before endoscopy, particularly in patients older than 45 years, if the diagnostic yield of gastric cancer in the early curable stages is to be maximized.
From the Northern Oesophago-Gastric Cancer Unit, The Royal Victoria Infirmary, Queen Victoria Infirmary, Newcastle upon Tyne, England.
RELATED ARTICLE
The Archives of Family Medicine Continuing Medical Education Program
Arch Fam Med. 2000;9(4):375-377.
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