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GPs urged not to use PPIs long term

GPs could save their practices thousands of pounds a year by following NICE guidelines on the use of proton-pump inhibitors (PPIs) and lowering doses or offering patients alternative therapies.

GPs attending a King's Fund symposium on dyspepsia in primary care this week will also be warned of the dangers of prescribing PPIs to patients on a long-term basis.

Dr Paul Pickering, a GP in Bridlington, Yorkshire, will tell the conference how his surgery launched a six-month trial following NICE guidelines for the prescription of PPIs and saved the equivalent of £21,000 a year by reducing or cutting out entirely the prescription of PPIs for some patients with mild dyspepsia.

Six months after being moved from PPIs to other treatments, 71 per cent of patients remained off PPIs and 74 per cent of patients whose dose had been reduced to maintenance levels remained on that dose. Similar trials in Scunthorpe and Hartlepool have also been successful, said Dr Pickering.

He added that not only were alternative treatments such as alginates available for many dyspepsia sufferers but the way PPIs were prescribed could be dangerous for patients.

He said: 'No-one knows what the long-term consequences of not producing acid are. PPIs are only licensed for short-term use but more and more patients are on them long-term.'

NICE recommends patients with mild GORD symptoms and/or those who do not have a proven pathology can frequently be managed with alternative therapies, including antacids, alginates, or H2 receptor antagonists. Patients presenting to GPs with mild dyspepsia may be treated on either a 'step-up' or 'step-down' basis. Neither group should normally be treated with PPIs long-term without a confirmed clinical diagnosis.

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