In Scotland over the last 31 years the incidence of gastric cancer has significantly declined by 0.6% per annum in males and 1.1% in females. In contrast, for oesophageal cancer, incidence rates have risen significantly by 3.0% and 2.0% per annum in males and females respectively. Increasing incidence of both adenocarcinomas and squamous carcinomas of the oesophagus in men and squamous and recently adenocarcinomas in women has been observed. This cannot be entirely accounted for by a growth in the proportion of histologically verified (HV) tumours over time. The incidence of adenocarcinoma of the stomach increased over the study period, most likely because of increasing proportions of HV tumours and improved diagnostic precision. Areas with high levels of deprivation in Scotland are strongly associated with high rates of oesophageal cancer in men, and of gastric cancer in both men and women. All these observations are discussed in the context of current knowledge of risk factors for these diseases.