Objective. Endoscopy is the gold standard for diagnostic evaluation of upper gastrointestinal symptoms. The relation between endoscopy and use of antisecretory medication on a population level is unknown. The aim of this study was to describe development in the number of patients undergoing first- time endoscopies and their use of antisecretory medication. Material and methods. Data on the use of endoscopies and antisecretory medication (H2 blockers and proton- pump inhibitors) were extracted from five population- based databases and included all citizens in Funen County (population 470,000) who had first time endoscopies between 1993 and 2002. Results. A total of 7,829 first- time endoscopy patients were identified. In 2002 the number of first- time endoscopies as 5.6/1000 persons. The proportion that had redeemed prescription(s) on antisecretory medication the last year before endoscopy increased from 33% (1095/3286) in 1993 to 41% (1012/2445) in 2002 (p = 0.000). Following endoscopy, average use of antisecretory medication increased by 90 defined daily doses (DDD)/patient/year (95% CI 84- 96) in patients with oesophagitis (N = 4850), by 59 DDD/patient/year (95% CI 54- 64) in peptic ulcer patients (N = 4373) and by 18 DDD/patient/year (95% CI 16- 20) in patients with normal endoscopies (N = 16,400). Conclusions. An increasing proportion of patients are treated with antisecretory medication before endoscopy. Following endoscopy, use of antisecretory medication increases irrespective of the diagnostic findings. Objective. Endoscopy is the gold standard for diagnostic evaluation of upper gastrointestinal symptoms. The relation between endoscopy and use of antisecretory medication on a population level is unknown. The aim of this study was to describe development in the number of patients undergoing first- time endoscopies and their use of antisecretory medication. Material and methods. Data on the use of endocyst and proton-pump inhibitors) were extracted from five population-based databases and included all citizens in Funen County (population 470,000) who had first time endoscopies between 1993 and 2002. Results. A total of 7,829 first-time endoscopy patients were identified. In 2002 the number of first-time endoscopies as 5.6 / 1000 persons. The proportion that had redeemed prescription (s) on antisecretory medication the last year before endoscopy increased from 33% (1095/3286) in 1993 to 41% (1012/2445) in 2002 (p = 0.000). Following endoscopy , average use of antisecretory drugs increased by 90 defined daily doses (DDD) / patient / year (95% CI 84-96) in patients with oesophagitis (N = 4850) 64) in peptic ulcer patients (N = 4373) and by 18 DDD / patient / year (95% CI 16-20) in patients with normal endoscopies (N = 16,400). Conclusions. An increasing proportion of patients are treated with anti- Following endoscopy, use of antisecretory salesills irrespective of the diagnostic findings.