Failing the acid test: benefits of proton pump inhibitors may not justify the risks for many users.

A STAGGERING 113.4 MILLION PRESCRIPtions for proton pump inhibitors (PPIs) are filled each year, making this class of drugs, at $13.9 billion in sales, the third highest seller in the United States. These medications are effective for treatment of erosive and ulcerative esophagitis, Barrett esophagus, ZollingerEllison syndrome, and gastroesophageal reflux disease (GERD), as well as for short-term treatment of ulcer disease, as part of a combination regimen for Helicobacter pylori eradication and for prevention of ulcers due to nonsteroidal anti-inflammatory drugs. However, these indications do not account for more than a hundred million prescriptions. So it should come as no surprise that PPIs have been shown to be overprescribed; between 53% and 69% of PPI prescriptions are for inappropriate indications.