Emily Lyon, a 23-year-old from Cambridge, experienced severe digestive symptoms this year, including intense abdominal cramps, bloating, and diarrhea that forced her to leave her retail job and pause her theatre studies. After losing nearly three stones over two months and enduring frequent bouts of illness that left her bedridden, she was diagnosed with small-intestinal bacterial overgrowth (SIBO), a condition characterized by an abnormal increase of bacteria in the small intestine.
Emily’s condition is believed to be linked to long-term use of proton pump inhibitors (PPIs), a class of medication commonly prescribed to treat acid reflux by reducing stomach acid production. She was first prescribed PPIs such as omeprazole at age 17 to manage her chronic heartburn, which had become debilitating. While the medication alleviated her acid reflux pain, the side effects associated with prolonged PPI use—including SIBO—have significantly impacted her quality of life.
SIBO can cause symptoms such as bloating, flatulence, and diarrhea, which align with Emily’s experience. A 2024 review of 29 studies published in the Journal of Clinical Medicine found that each additional month of PPI use raises the risk of developing SIBO by 4.2 percent, with particularly increased risk after six months of continuous treatment. The condition is thought to arise because stomach acid normally helps control bacterial populations; suppressing acid production allows bacteria to proliferate abnormally in the small intestine.
Despite these concerns, stopping PPIs can be difficult. Emily reports that attempts to discontinue her medication lead to a severe return of reflux symptoms, describing the pain as “unbearable.” This rebound effect, medically known as acid rebound hypersecretion, occurs due to increased production of gastrin, a hormone that promotes acid secretion. The suppressed acid production returns forcefully once the medication is stopped, often compelling patients to resume PPI use.
PPIs are among the most frequently prescribed medications in the UK, with about 73 million prescriptions dispensed in England during 2022-2023. National guidelines typically recommend short-term usage with annual reviews for long-term users. However, research suggests many patients remain on PPIs for extended periods without appropriate reassessment. One study involving 77,000 patients found that only 4 percent of long-term PPI users had a clear indication for prolonged treatment.
Experts caution that PPIs are sometimes prescribed too broadly, even in cases where acid is not the root cause of symptoms. Gastroenterologists note that while the drugs provide valuable benefits—such as healing gastric ulcers and preventing progression of acid-related conditions like Barrett’s esophagus—they also carry potential risks. A large study published in Nature Communications linked PPI use to increased risks of various diseases, including heart disease, diabetes, and respiratory infections, highlighting the need for careful evaluation of long-term treatment.
Managing PPI discontinuation can involve tapering dosages to minimize rebound symptoms. Additional strategies to control reflux include lifestyle modifications such as elevating the head of the bed, avoiding caffeine, alcohol, and chocolate, and using alternative medications like H2 blockers or alginate-based treatments.
Emily awaits surgery to repair a hernia believed to be contributing to her reflux but remains caught in a cycle of medication dependency. She hopes the operation will provide relief and allow her to reduce or stop her PPI use, describing her current situation as profoundly disruptive. Medical professionals emphasize the importance of balancing the benefits and risks of PPIs and tailoring treatment plans to individual patient needs.