Intended for healthcare professionals

Practice Practical Prescribing

Proton pump inhibitors

BMJ 2023; 383 doi: (Published 13 November 2023) Cite this as: BMJ 2023;383:e070752

Linked Editorial

Better prescribing for safer, more effective healthcare

  1. Danny Jenkins, foundation doctor1,
  2. Ines Modolell, consultant gastroenterologist2
  1. 1Lewisham and Greenwich NHS Trust, London, UK
  2. 2Cambridge University Hospitals, Cambridge, UK
  1. Correspondence to: D Jenkins Daniel.jenkins8{at}

What you need to know

  • Discuss with patients the importance of lifestyle modification for the long term management of acid reflux disorders

  • Discuss with patients that a prescription may be stopped even if it has improved symptoms

  • Side effects of PPIs include gastrointestinal disturbance, higher rate of fractures, and increased susceptibility to Clostridium difficile infection

  • Review new prescriptions of proton pump inhibitors (PPIs) at four weeks, and regularly thereafter, assessing for improvement in symptoms and quality of life

A 42 year old man visits his general practitioner with a three month history of intermittent nausea and central chest discomfort, particularly after fatty and sweet meals. He occasionally has a bad taste in his mouth when he wakes up from sleep. His body mass index is 32, he has no significant medical history, and he takes no regular medications. After asking him about alarm symptoms, you make a diagnosis of gastro-oesophageal reflux disease. You are considering prescribing a proton pump inhibitor as a first line therapy.

How often are proton pump inhibitors prescribed and how do they work?

Prevalence of proton pump inhibitor (PPI) use is about 15% of the UK population, according to two primary care database studies.12 In 2022-23, 73 million NHS prescriptions for PPIs were dispensed in England at a cost of about £190 million, equating to 1.8% of total primary care prescription costs and 6% of all prescriptions dispensed.3 The two most commonly prescribed PPIs in England are omeprazole and lansoprazole, which were among the five most commonly dispensed drugs in 2020.

There is strong evidence to support the use of PPIs across a range of indications.4 PPIs are used in the treatment of upper gastrointestinal disorders characterised by excessive acid production and damage to upper gastrointestinal tissue,5 and are also prescribed as gastroprotection for patients being treated with medications which increase the risk of ulceration, such as non-steroidal …

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