Proton pump inhibitors are one of the most frequently prescribed classes of drug in the world because they combine a high level of efficacy with low toxicity. In 2006, expenditure on these drugs was £425m (€595m; $872m) in England1 and £7bn globally.2 Yet studies consistently show that proton pump inhibitors are being overprescribed worldwide in both primary and secondary care.3456789 Between 25% and 70% of patients taking these drugs have no appropriate indication. This means that, at the very least, £100m from the National Health Service (NHS) budget and almost £2bn worldwide is being spent unnecessarily on proton pump inhibitors each year.

The first generic proton pump inhibitor (omeprazole) was introduced in 2002 and now comprises more than four fifths of all prescriptions for proton pump inhibitors in the United Kingdom. In the five years since the introduction of omeprazole, precriptions for proton pump inhibitors have doubled, although the reasons for the this rise are not obvious.1 Despite this substantial increase in drug usage, …