The National Health Service is wasting a whopping £100 million a year on prescribing proton pump inhibitors for treating indigestion, according to a report in the British Medical Journal.

The editorial by Ian Forgacs, consultant physician, and Aathavan Loganayagam, specialist registrar, both from King’s College Hospital, describes how £425 million in England (and £7 billion globally) was spent on PPIs in 2006, but that “between 25% and 70% of patients taking these drugs have no appropriate indication”.

PPIs, such as omeprazole, are effective in inhibiting acid production in the stomach, but Forgacs and Loganayagam argue that healthcare professionals are ignoring prescribing guidelines by dishing out such drugs far too readily, particularly as less expensive alternatives, such as H2 receptor antagonists, could be used in many patients instead. PPI prescriptions now swallow more than 90% of the NHS medicines budget for treating dyspepsia, they stress.

Furthermore, they claim the problem extends beyond primary care and that evidence of “inappropriate use” of PPIs in secondary care is “abundant”, with 67% of hospital inpatients taking them noting meet the National Institute for Health and Clinical Excellence’s criteria.

There is no doubt that PPIs represent “a tremendous therapeutic advance” and that they have, in the long-term, transformed the lives of many patients with gastro-oesophageal reflux disease and associated complications, Forgacs and Loganayagam concede, but conclude that these drugs are “clearly being overused”.

Identifying the problem key
Commenting on the report, NICE said in a statement: “It is always disappointing when our recommendations are not consistently followed”, and explained that, in many patients, PPIs should only be used for a short period of time until the underlying cause of the problem is identified.

“Although side effects from proton pump inhibitors are rare and the risk to patients is low, it is important to remember that every pound spent unnecessarily on these drugs will take away resources from other patients,” it stressed, and “strongly urged” primary care trusts to follow its PPI prescribing criteria to ensure they are ”targeting resources where they are most likely to offer benefit.”