When introduced in the 1990s it seemed almost miraculous – a cheap tablet with few side effects that promised to banish the misery of heartburn caused by acid reflux.
No wonder, then, that omeprazole quickly became one of the UK’s most commonly prescribed drugs. Today, around ten million people regularly take it – or similar drugs such as lansoprazole – costing the NHS about £300million a year.
But the soaring number of prescriptions – some 75million a year – has sparked concern that, although the pills are intended for short-term use, many patients are taking them for years at a time – or even decades.
Experts have repeatedly warned that the drugs, collectively known as proton-pump inhibitors (PPIs), are being over-prescribed and do little to treat the underlying causes of reflux. And there is mounting evidence that long-term use causes additional health problems – disrupting the digestive system and leaving patients vulnerable to stomach infections.
Research has even suggested taking PPIs for a long time could increase the risk of kidney disease, mental health problems, bone-thinning osteoporosis, cancer, Parkinson’s and dementia.
With experts frustrated at the inaction of the health service, they are now calling for new guidelines to rein in ‘unnecessary’ use of omeprazole and other PPIs.
Instead of automatically writing a prescription, they believe GPs should ask patients to alter their diet and lifestyle – which, in many cases, could effectively manage, or even cure, their heartburn symptoms.
They are also demanding better education about the tell-tale signs that PPIs are causing problems, such as bloating, excessive belching, diarrhoea and repeated infections such as gastroenteritis. Crucially, they’ve also suggested regular medication reviews to prevent patients being stuck on a repeat prescriptions indefinitely.
Clinical gastrointestinal scientist Professor Anthony Hobson has described the prevalence of PPIs as ‘a huge problem’
Around one in five Britons suffers from acid reflux, which occurs when stomach acid leaks into the oesophagus and throat, causing a burning sensation and chest pain
Clinical gastrointestinal scientist Professor Anthony Hobson, who has worked with acid reflux patients for 35 years, described the prevalence of PPIs as ‘a huge problem’. He said: ‘Millions are unnecessarily taking tablets that aren’t doing anything to cure their problem, and could be doing serious harm.
‘There’s nothing wrong with these medications if used properly – they’re extremely effective, short-term, at treating symptoms of acid reflux. However, far too many patients are started on a PPI, it gets their reflux under control, but then they’re left on the drug for years, creating other problems. It’s lazy medicine. We’re long overdue new guidelines, more safeguards and greater awareness of risks.’
So why are so many people on PPIs for so long? And if someone has been taking the pills for years, what should they do?
Around one in five Britons suffers from acid reflux. The condition occurs when stomach acid leaks into the oesophagus and throat, causing a burning sensation and chest pain, plus nausea, a sore throat and bad breath.
While some suffer only intermittently, others are diagnosed with GORD (gastro-oesophageal reflux disease), a chronic condition caused by frequent reflux.
Left untreated, leaking acid can permanently damage the lining of the oesophagus, causing inflammation, ulcers and an increased risk of oesophageal cancer.
Typically, reflux is caused by a loose valve between the oesophagus and stomach, or else by a hiatus hernia where the top of the stomach pushes upwards and stops the valve closing properly.
It’s often exacerbated by factors such as too much fatty food, alcohol or caffeine. Smoking and obesity can also increase reflux, as can pregnancy and stress.
Around ten million people regularly take omeprazole – or similar drugs such as lansoprazole – costing the NHS about £300million a year
As a result, said Prof Hobson, many patients – even those with a hiatus hernia – can manage their reflux by altering their daily routines and diet. He added: ‘Burgers, hot dogs and fish and chips are a common trigger, as fat takes a long time to digest, meaning the stomach can get backed up, pushing acid up into the oesophagus. Caffeine, which acts as a muscle relaxant, can loosen the stomach valve, meaning too much tea and coffee can be a problem.
‘Spicy foods such as curry and acidic things like lemons and oranges are also common culprits, while excess weight increases the likelihood of heartburn as it puts extra pressure on the gut.’
He explained that cutting out known trigger foods, losing weight and reducing stress – as well as taking over-the-counter antacids such as Rennie, Gaviscon or Pepto-Bismol to neutralise acid that has leaked into the oesophagus – can help many patients reduce or even cure their symptoms within weeks.
Severe reflux may require surgery to reinforce the stomach valve or to fix the hiatus hernia.
The widespread introduction of PPIs in the early 1990s presented another option. The drugs bind to cells in the body called proton pumps, drastically reducing production of stomach acid.
Prof Hobson said: ‘Reflux can be very nasty. It can feel like swallowing razor blades, and acid coming up from your stomach can feel like sandpaper rubbing inside your chest. So when PPIs arrived, it felt like a miracle.
‘They produced an 80 per cent suppression of stomach acid and were much more effective than any previous medications.’
A short course lasting six to eight weeks can stop the irritation caused by the acid and give the oesophagus time to heal.
‘But it won’t address the root cause,’ warned Prof Hobson. ‘Sadly, PPIs have become a crutch for GPs and gastroenterologists.
‘Rather than ask patients to make changes to diet and lifestyle, they hand them what feels like a magic pill and let them carry on with their bad habits.’
A new survey of reflux patients for The Functional Gut Clinic in London, where Prof Hobson is medical director, confirmed many doctors are automatically reaching for the prescribing pad. Overall, it found that GPs were much more likely to offer drugs for acid reflux than lifestyle advice. Some 86 per cent of patients were offered drugs – including 60 per cent who were offered PPIs – while only one in four (26 per cent) were given a diet plan.
Alarmingly, the survey found many patients ended up on PPIs long term, with 34 per cent taking them for more than five years, including 20 per cent who took them for a decade or more.
In recent years, low-dose PPIs have also been sold in pharmacies without a prescription.
In 2017, the journal Gut reported that long-term PPIs were associated with four extra cases of stomach cancer a year for every 10,000 people taking the pills. Another study in the medical journal Cureus later linked PPIs to greater risk of chronic kidney disease.
Yet another concern is the increased risk of mental health problems and dementia, as the pills can reduce the body’s ability to process vitamin B12.
The compound – which is vital for maintaining the nervous system and protecting cognitive function – is absorbed in the body when stomach acid breaks down food during digestion. But with PPIs reducing acid production, the body may not be able to take in enough.
Prof Hobson added: ‘Stomach acid is there for a reason. It’s critical for breaking down proteins in food and killing off the harmful bugs you swallow.
‘Without it, the body struggles to absorb B12 properly or other important chemicals such as calcium and magnesium.’
He claimed that, ‘while the jury is still out’ on the links between long-term use of PPIs and some of the most serious conditions, there was no doubt the drugs could impact patients’ digestive systems.
‘PPIs are putting millions of people at risk of gut infections,’ he said. ‘Research shows you are five times more likely to get gastroenteritis or food poisoning if on a PPI long-term, and you are susceptible to getting these infections over and over.’
He warned that extended use of PPIs damaged the gut microbiome, the community of bacteria and ‘friendly’ microbes in the stomach, adding: ‘Patients develop other symptoms which they don’t necessarily associate with the drugs, such as belching, bloating, flatulence and explosive diarrhoea. They may not have reflux any more, but they are putting up with some miserable symptoms. Stopping the PPI could improve their health and quality of life.’
Prof Hobson said that both doctors and patients ‘need to be aware these symptoms could be a red-flag that the gut microbiome is being affected’.
As well as acid reflux, PPIs are widely prescribed for indigestion and stomach ulcers, to treat persistent coughs, and to protect the stomach from long-term use of other medicines such as low-dose aspirin, anti-inflammatories such as ibuprofen and naproxen, as well as anticoagulants which are given to people at high risk of life-threatening blood clots.
PROF Hobson added: ‘There are definitely some people – a minority – for whom the benefits of taking long-term PPIs outweigh the risks. But it’s often not something patients have ever discussed with their doctor.’
His recommendation for anyone taking PPIs long-term is to book an appointment with their GP to discuss why they are still being prescribed the drug and whether it is helping.
Patients should also ask if diet and lifestyle changes would be beneficial, or whether another course of action could be considered – such as an endoscopy to investigate the cause of the reflux and to decide whether surgery is needed.
However it’s important not to simply stop taking a PPI, as it can cause a ‘rebound’ effect where the body temporarily over-produces acid – resulting in even more severe reflux symptoms. Instead, the dose should be gradually reduced over a number of weeks, under medical supervision.
Prof Hobson said: ‘There needs to be clearer official guidance for clinicians to reaffirm to GPs that these medications are designed for short-term use – and that, if they are prescribed long term, there should be a regular review.’
Last night, a spokesman for the Medicines and Healthcare products Regulatory Agency said: ‘The product information for all PPIs recommends that patients on long-term treatment, especially when exceeding a treatment period of one year, should be kept under regular surveillance.’
Taking drug for 16 years has left me with chronic kidney disease
Company director Jeremy Asfour was diagnosed with chronic kidney disease, which he believes is the result of taking omeprazole for 16 years
Jeremy Asfour believes that taking omeprazole for 16 years has left him suffering with chronic kidney disease.
The company director, 48, started taking the drug in 2008 to manage ‘aggressive’ reflux. He said: ‘I was waking in the night, choking on acid, stabbing pains in my chest.’
The reflux started after Jeremy, from East Sussex, took steroids and then auto-immune drugs for ulcerative colitis. While treatment put the bowel disease into remission, his GP continued to prescribe omeprazole for ten years. Jeremy said: ‘There was no real explanation or discussion.’
In 2024, a routine test showed Jeremy was suffering the early stages of chronic kidney disease, where the damaged organs can’t filter blood as effectively as they should.
He decided to wean himself off omeprazole, lowering the dose over several months.
Two years after stopping the drug, tests show a significant improvement in his kidney function. He said: ‘There needs to be greater awareness of the risks associated with long-term use of PPIs.’
He now manages reflux with a drug-free regime of meditation, avoiding trigger foods and not eating after 6.30pm.