Is it really reflux? Why you might be mis-prescribed PPIs

The findings reveal that 92% of people prescribed PPIs have not had proper testing to confirm whether they actually have GORD. This may mean many are taking acid-suppressing medicine long-term without needing it, which can have unintended health consequences.

Professor Anthony Hobson of The Functional Gut Clinic, and host of The Functional Gut Diaries

What the research found

The survey found that 92% of participants had been offered PPIs, and 84% were still on repeat prescriptions. Over half (56%) had been taking them for more than two years, a third (34%) for over five years, and one in five for more than ten years.

However, despite this widespread prescribing, NHS gastroenterology services remain hard to reach.

A third of patients have never seen a gastroenterologist, another third have only been once, and just 15% see a specialist regularly.

The research shows that only 8% of people surveyed - even those on long-term use of the medicine - have had proper diagnostic tests, such as pH monitoring. This checks how much acid is in your oesophagus - a tube that connects your throat to your tummy.

Gaps and concerns in GORD diagnosis

Many people with GORD are treated in NHS primary care in a variety of ways.

The new survey found that 46% of respondents were diagnosed by a doctor, with 36% seen in person and 10% seen virtually.

Overall, 86% were prescribed or advised to take medicine by their doctor - 26% were given over-the-counter options such as Gaviscon or Rennie, while 60% were started on PPIs.

In many cases, a GORD diagnosis is added to a patient’s records based solely on their response to PPI treatment, which, as noted above, is not recommended by the BSG.

Some patients have concerns about their GORD care. Around 8% felt their diagnosis wasn’t properly investigated, and 1 in 4 (24%) thought their treatment relied too much on how their body responded to PPIs. Another 8% believed they had been misdiagnosed, while 1 in 3 said PPIs 'just mask the symptoms rather than treating the problem.'”

A clear diagnostic gap in GORD care

Hobson believes the research highlights a lack of proper testing how GORD is currently diagnosed.

“The vast majority of patients prescribed PPIs are treated on clinical suspicion alone - because their symptoms appear to fit. Very few undergo pH monitoring or any form of objective testing. In many cases, long-term medicine is initiated following a brief GP consultation, without specialist input or diagnostic confirmation.

“We don’t yet know the true scale of misdiagnosis, simply because formal testing is so rarely performed. But based on our clinical experience and the latest survey data, we estimate that at least 30% of long-term PPI users may not have confirmed acid reflux at all. That’s potentially millions of people medicated for a condition they may not actually have.”

Experts call for better testing and referrals

The findings funded by The Functional Gut Clinic suggest it’s time to take a fresh look at how GORD is diagnosed and treated, fix the gaps in seeing specialists, and make sure diagnosis and prescriptions follow national guidance.

The survey suggests that millions of people are taking long-term medicine without a proper diagnosis, and health experts are urging the NHS to focus on proper testing and referral to specialists.

Dr Philip Woodland, Consultant Gastroenterologist and Senior Lecturer at the Royal London Hospital, Barts Health NHS Trust, agrees that in some cases a diagnosis of GORD is made based solely on symptoms.

“However, millions of people continue PPIs on repeat prescription despite having incomplete symptom response - so the treatment helps a bit, but they still experience issues,” he says. “The result is over-prescription of PPI on the NHS.

“There are two things that could be done to improve the situation. In primary care there could be better understanding about treatment alternatives, such as non-drug interventions such as avoiding trigger foods or reducing alcohol. In secondary care we need to focus on improved diagnostics. Accurate diagnosis in these patients could lead to more rational and effective treatment alternatives.”