Dear Patient,

Subject: Review of Your Long-Term Acid-Reducing Medication (PPI)

We are reviewing patients who have been taking proton pump inhibitors (PPIs) for a long time. These include omeprazole, esomeprazole, lansoprazole, pantoprazole and rabeprazole.

Our records indicate that you have been prescribed a PPI, mainly to manage symptoms of acid reflux (GORD) or gastritis.

Why are we reviewing your medication?

PPIs are effective medicines for reducing stomach acid and treating conditions such as heartburn, reflux and stomach ulcers. However, some patients continue taking them longer than necessary.

Long-term PPI use has been associated with certain risks, including:

• Gastrointestinal infections, particularly Clostridioides difficile
• Increased risk of bone fractures
• Low magnesium levels and vitamin B12 deficiency
• Possible increased risk of kidney problems
• Potential to mask symptoms of more serious stomach conditions

Some of these associations have not been proven to be caused directly by PPIs. Nevertheless, we recommend using the lowest effective dose for the shortest appropriate duration.

Important: Who may need long-term PPI treatment?

Some patients need to continue taking PPIs long-term, particularly those with:

• Barrett's oesophagus
• Severe oesophagitis
• Chronic Hiatus hernia
• Stomach or duodenal ulcers
• An increased risk of gastrointestinal bleeding due to medications such as being on:
  • Non-steroidal anti-inflammatory drugs (NSAIDs), e.g. ibuprofen or naproxen
  • Blood thinners (anticoagulants), e.g. apixaban, rivaroxaban or warfarin
  • Antiplatelet medications, e.g. aspirin or clopidogrel

If you have been advised to continue a PPI for any of these reasons, please do not stop taking it without first discussing this with a clinician.

What do we recommend?

If there is no ongoing medical reason for you to continue taking a PPI, we recommend gradually reducing and, if possible, stopping it. If you have been taking a PPI regularly for a long time, stopping suddenly may temporarily increase stomach acid production, causing rebound heartburn or reflux. To minimise this, you could:

1. Take your PPI every other day for 1–2 weeks.
2. Stop taking it if your symptoms remain manageable.
3. Use an over-the-counter antacid or alginate, such as Gaviscon, when needed for temporary symptom relief.

Symptoms may temporarily return after stopping but often settle within a few days to weeks.

Lifestyle changes to help control acid reflux

Many patients can manage their symptoms through simple lifestyle changes:

• Avoid foods and drinks that trigger your symptoms, such as caffeine, chocolate and fatty foods.
• Avoid eating within 2–3 hours of bedtime.
• Raise the head of your bed if you experience reflux at night.
• Maintain a healthy weight.
• Reduce alcohol consumption and stop smoking.

For support with weight management, physical activity or smoking cessation, you can contact Feel Good Suffolk:

https://feelgoodsuffolk.co.uk/
Tel: 0345 603 4060

For more information, please see links below:

NHS – Heartburn and acid reflux:
https://www.nhs.uk/conditions/heartburn-and-acid-reflux/

Cambridge University Hospitals – Dietary and lifestyle advice for GORD:
https://www.cuh.nhs.uk/patient-information/dietary-and-lifestyle-advice-for-adults-with-gastro-oesophageal-reflux-disease-gord/

When should you seek further advice?

Please speak to your community pharmacist or one of our practice pharmacists if:

• You are unsure whether you should reduce or stop your PPI.
• Your symptoms occur twice or more per week after four weeks without your PPI.
• Your symptoms significantly worsen or interfere with daily activities.

Please seek prompt medical assessment if you develop difficulty swallowing, persistent vomiting, unexplained weight loss or black stools. Vomiting blood requires urgent medical attention.

Thank you for helping us ensure your medication remains safe and appropriate.

Yours Sincerely

Dr Ehasan Ahmadi

Barrack Lane Medical Centre

Published: Nov 11, 2026