Why Are So Many People Taking Proton Pump Inhibitors?

Is there an epidemic of acid reflux, or is something else going on?

Photo by Towfiqu barbhuiya on Unsplash

I was sitting in my med school physiology class in the mid-1990s when I first learned about an incredible medication for acid reflux. It was the most potent way to stop acid production, and it did so by permanently binding to proton pumps–the pumps that make acid in the stomach lining. That medicine was called Nexium, the brand name version of omeprazole. It was the first drug of a class called proton pump inhibitors (PPIs) that would revolutionize the treatment of gut ailments.

At the time, the first-line drugs for acid reflux were H2 blockers, like Tagamet and Pepcid. They were great for handling the consequences of late-night cheeseburger binges and beer bong parties because they only temporarily reduced acid production. But some people needed all their acid production turned off. They had more severe problems like Barrett’s esophagus, which can lead to cancer, and gastritis, which can lead to bleeding ulcers. Nexium filled in this gap. There are now eight brand-name PPIs in the U.S. For many patients PPIs were–and still are– true lifesavers.

Fast forward to 2009. CNN reported that PPIs were the third most-prescribed drug in the country, representing 110 million prescriptions and $13.6…