10 Several studies suggest that a substantial proportion of PPI users do not have a clear indication for therapy (Table 1). 2,10 Long-term use is only recommended in selected populations 11,12 but data indicate that this accounts for most of the total use. 1,9 Not surprisingly, there is growing international concern over their increasing use. 1 Over the last decade, at least two PPIs have featured in the top 10 most prescribed PBS-subsidised medicines every year. Since their introduction in the early 90s, PPI use has increased by more than 1000% in Australia, 2 with over 19 million prescriptions in the 2013–14 financial year. While highly effective with a favourable safety profile, use of PPIs is not without concern. Although both classes of medicines provide symptom relief in GORD, PPIs are significantly more effective than H 2 antagonists at relieving symptoms and healing oesophagitis. 6The discovery of gastric-acid suppressing medicines – H 2-receptor antagonists and proton pump inhibitors (PPIs) – marked a change. 4 Complications from these disorders were a persistent problem in gastroenterology, 5 the only effective long-term treatment being surgery. Until the late 20th century, acid–peptic disorders such as gastro-oesophageal reflux disease (GORD) condemned those affected to a lifetime of ineffective dietary restrictions and antacids.
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