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'Rejection has left us fed up'

NICE is under intense pressure to revise its guidance on referral for dyspepsia after a new audit found it would miss almost half of patients with gastric cancer.

Leading specialists told Pulse there was a furious row behind the scenes, but they understood NICE would be forced to backtrack when it releases its delayed cancer referral guidance in June.

They said the NICE guidance was a 'death sentence' and urged GPs to ignore it.

The guidance, released last August, advises GPs to 'test and treat' over-55s with uncomplicated dyspepsia and refer for endoscopy only if symptoms persist. But an audit of 343 patients found 41.8 per cent with gastric cancer and 11.2 per cent with oesophageal would have been missed by this policy.

Professor Michael Griffin, president of the Association of Upper Gastrointestinal Surgeons of Great Britain, said he had been consulted on the forthcoming cancer referral guidelines and understood they wouldbe different from existing advice.

'The cancer guidelines have been delayed. I am certain it is because they are at odds with the rubbish put out by NICE on dyspepsia. I am sure they are agonising over what to do.'

Dr Pawan Randev, chair of the cancer primary care working group, said: 'I understand there is a significant battle occurring behind the scenes.'

The audit results were presented to an Association of Surgeons of Great Britain and Ireland conference this month, where surgeons voted 128 to two to insist the guidance was revised.

The study found NICE guidance would miss early, potentially curable, oesophageal cancers and a mixture of earlier and later gastric cancers.

Study leader YKS Viswan-ath, gastrointestinal consultant at James Cook University Hospital in Middlesbrough, said: 'A good proportion of patients with potentially curable disease would not have been referred according to NICE. We think the guidelines are to be broadened. Age should not be a criterion for urgent referral.'

NICE said current Department of Health guidelines on referral would remain in place pending the new guidelines.

But Professor Griffin said: 'Most people are not adhering to this guidance I am pleased to say.

'It would be going back 30 years and saying those cancers are a death sentence.'

He urged GPs to refer all patients over 45 with dyspepsia for two weeks or longer.

By Cato Pedder

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