Experts say far too much is spent on needless indigestion drugs

Jan 7 2008

According to two experts in Britain the National Health Service (NHS) is needlessly spending at least £100m per year on indigestion drugs.

The gastroenterologists from King's College Hospital, London, say that proton pump inhibitors (PPI's) such as omeprazole, which inhibit the backflow of the stomach acid that causes dyspepsia (indigestion), are the most commonly prescribed classes of drug worldwide.

Globally £7bn was spent on these drugs in 2006, £425m of that in the the UK; indigestion is very common and most people will suffer from have it from time to time.

While for some people it is a mild bout of discomfort after a large meal that goes away on its own or with medicine bought at a pharmacy without a prescription, for others it can be very frequent and painful and they may need to see a doctor for more powerful drugs.

The two experts say despite the fact that there are cheaper and equally effective alternative drugs available for many patients, prescriptions for proton pump inhibitors have superseded all other acid inhibiting agents and now make up 90% of the NHS drug budget for dyspepsia treatment.

Dr. Ian Forgacs and Dr. Aathavan Loganayagam say these relatively expensive drugs are being prescribed too readily, contrary to guidance and they accuse doctors of ignoring prescribing guidelines and say cheaper but still effective drugs can be given.

They suggest they are overused and they compare their use to giving morphine for a headache.

According to a study of hospitalized patients, 63% of Australian, 33% of Irish, and 67% of British patients who are taking proton pump inhibitors do not meet their country's criteria for taking the medication.

Another U.S. study of hospitalized patients found that the majority of them were taking these drugs needlessly at the time of discharge, while a Swedish primary care study of patients who had been taking PPI's for four years showed that 27% of them were able to stop taking the drug completely.

Audits of patients have repeatedly shown that far too many are taking PPI's needlessly but attempts to discourage doctors from prescribing them unnecessarily have been ineffective.

The authors say proton pump inhibitors have been an excellent therapeutic breakthrough and have improved the lives of patients with previously persistent symptoms, but they are being overused.

Experts say that although PPIs are safe drugs, they are not without side effects which should not be disregarded; research suggests they treble the risk of Clostridium difficile infection, and patients who take PPIs for more than a year are at increased risk of hip fracture.

The authors say global over-prescribing is a very real problem and it is important to find ways of motivating doctors to follow guidelines.

Experts advise patients with indigestion to look for causes which can easily be remedied, such as over-eating, excess alcohol intake, heavy smoking or rushed meals.