The guidelines, from the National Institute for Clinical Excellence, say that GPs should only refer patients suffering severe indigestion (dyspepsia) if they are showing "alarm symptoms".

Instead, say the guidelines, patients without alarm symptoms are to be treated with antisecretory drugs or other measures.

But senior gastrointestinal specialists say that if patients are only referred once alarm symptoms are present, cancer may already be at an advanced stage - and too late for surgery.

Professor Michael Griffin, head of the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, says that the guidelines are poorly researched and unsubstantiated. Though they mention poor outcomes for gastrointestinal (stomach and gullet) cancer sufferers in the UK, for instance, the guidelines ignore better results for patients in Japan and other Western countries - where a higher proportion of early gastric cancers are diagnosed.

The guidelines also undervalue endoscopy for diagnosing other serious and painful problems - such as inflammation of the gullet, or ulcers.

Until the evidence on endoscopy is properly assessed, GPs should continue to refer patients with continued severe indigestion for endoscopy, argue the authors.

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Contact: Emma Dickinson
edickinson@bmj.com
44-207-383-6529
BMJ-British Medical Journal
3-Feb-2005