Should You Stop Taking Omeprazole?

A GP has urged people taking common acid-reflux drugs to come off them as soon as they safely can. Long-term use does deserve regular review, but the case against PPIs is more complicated than it sounds, and some people should not stop them.

TL;DR

• PPIs are very effective drugs. Omeprazole, lansoprazole and esomeprazole suppress stomach acid and are used for reflux, ulcers and protection against gastrointestinal bleeding.
• Not everyone taking one long term still needs it. NICE recommends annual review for people on long-term treatment, stepping down to the lowest effective dose and considering as-needed use.
• The strongest safety evidence is a randomised trial, and it was reassuring. Over three years in 17,598 people, pantoprazole showed no increase in the conditions most often linked to PPIs, apart from a possible rise in enteric infections.
• The alarming claims come mostly from observational research. Studies link PPIs to chronic kidney disease and dementia, but they cannot show the drugs caused those conditions.
• Dementia is the clearest example. An umbrella review of 11 previous reviews concluded that a causal relationship appears unlikely.
• Stopping can temporarily make reflux worse. In a randomised trial, 44% of healthy volunteers developed acid symptoms after stopping a PPI, against 15% on placebo.
• Some people have strong reasons to continue. Severe oesophagitis, oesophageal stricture, Barrett's oesophagus and high bleeding risk are among them.

Why Are PPIs Suddenly Under Scrutiny?

Proton pump inhibitors are among the most familiar medicines in Britain. Omeprazole, lansoprazole and esomeprazole suppress stomach acid production and can be remarkably effective for heartburn and gastro-oesophageal reflux disease, usually shortened to GORD. The current controversy follows comments from the GP and author Dr Philippa Kaye, who says she encourages patients on PPIs to come off them as soon as they safely can. Her concern is not that the drugs fail to work, but that a medicine prescribed for a few weeks can become a repeat prescription that runs for years without anyone revisiting the original reason for it.

That concern is legitimate, and UK guidance already reflects it. NICE recommends that people who need long-term management of dyspepsia are reviewed annually, that treatment is stepped down to the lowest dose that controls symptoms, and that taking it only when needed is discussed. None of which is the same as saying long-term PPIs are inherently dangerous. The useful question is not whether everyone taking omeprazole should stop. It is whether everyone taking it still has a reason to continue.

What the Randomised Evidence Shows

Most of the frightening headlines about PPIs come from observational studies, so the most informative evidence is the one that isn't. The COMPASS trial randomised 17,598 people with stable cardiovascular disease to pantoprazole 40mg daily or placebo, with a median follow-up of three years, collecting data every six months on exactly the outcomes that worry people: pneumonia, Clostridioides difficile and other enteric infections, fractures, gastric atrophy, chronic kidney disease, diabetes, lung disease, dementia, cardiovascular disease, cancer, hospitalisation and death. Pantoprazole was not associated with any of them, with the possible exception of enteric infections, and even that risk was smaller than reviews of observational data had estimated.

Two limits matter. Three years is not twenty, and some harms could take longer to appear. And more than a third of the patients randomised in the wider trial were excluded from the PPI comparison because their own doctors judged that they needed a PPI continuously, so the trial tells us about people for whom stopping was a reasonable option in the first place.

What About Kidney Disease and Dementia?

This is where the public conversation usually goes wrong. Observational studies have linked PPI use with chronic kidney disease, dementia, cardiovascular disease and other outcomes, and some of those associations are substantial enough to deserve investigation. The difficulty is that people prescribed PPIs differ from people who are not, in age, illness, other medicines and how often they see a doctor. Researchers adjust for those differences, but adjustment cannot remove them.

A systematic review published in Cureus in January 2026 pooled 15 observational studies of kidney outcomes. Six of them, covering 594,680 people, found a significant increase in new chronic kidney disease among PPI users. But the analysis of disease progression produced a relative risk of 1.49 with a confidence interval of 0.84 to 2.65, which is not statistically significant, and heterogeneity between studies was 99.3%, meaning the studies disagreed with each other almost completely. The end-stage renal disease estimate was a relative risk of 1.15, just reaching significance, and the funnel plot suggested publication bias. That is a body of evidence worth watching rather than acting on alone.

Dementia is the clearer cautionary tale. An umbrella review published in Digestive Diseases and Sciences examined 11 systematic reviews and meta-analyses covering 21 studies. Most found no link, none of the six that looked specifically at Alzheimer's disease found a significant association, and the authors concluded that, given the low certainty of the evidence, a true causal relationship appears unlikely. An updated meta-analysis published in January 2026 reached a similar conclusion, finding no clear or consistent evidence that PPIs increase the risk of dementia or Alzheimer's, while noting extreme heterogeneity between studies.

So "PPIs cause dementia" is not a reasonable summary of the research, and a list of observational associations is not a good reason on its own to stop a medicine that has a clear purpose.

The Effects That Are Recognised

None of this means PPIs are free of effects. Suppressing stomach acid changes more than heartburn, because acid plays a part in digestion, in absorbing some nutrients and in limiting the organisms that survive the journey into the gut. Low magnesium is a recognised consequence of longer-term treatment, and the 2026 review found hypomagnesaemia and acute kidney injury more frequent among PPI users. Vitamin B12 deficiency, gut infections and fractures have all been associated with prolonged use, and PPIs can rarely cause acute interstitial nephritis, an inflammatory kidney reaction also seen with other drugs. The distinction that matters is between these recognised effects and the much longer list of diseases statistically associated with PPI use; treating them as the same thing is what turns a sensible case for review into a case for stopping.

Why Stopping Can Make Heartburn Worse

There is a peculiar complication in finding out whether you still need a PPI: stopping it can itself increase acid production, a phenomenon known as rebound acid hypersecretion.

The evidence here is randomised, not anecdotal. Danish researchers gave 120 healthy volunteers with no history of reflux either esomeprazole 40mg for eight weeks followed by four weeks of placebo, or twelve weeks of placebo. In the four weeks after the drug was withdrawn, 44% of the group that had taken the PPI reported heartburn, acid regurgitation or indigestion, against 15% of those who had taken placebo throughout. These were people who had nothing wrong with them to begin with.

That creates an obvious trap. Someone stops omeprazole, develops heartburn within a fortnight, concludes their reflux has returned and restarts. Sometimes it has. But rebound makes the two hard to tell apart, which is why the AGA advises warning anyone stopping long-term treatment to expect transient symptoms. How best to stop is less settled than you might expect: some NHS deprescribing protocols favour reducing the dose gradually over several weeks, with antacids or alginates for breakthrough symptoms, while the AGA says either tapering or abrupt discontinuation can be considered, because the evidence does not establish one as superior. So "never stop suddenly" is too absolute, though planning withdrawal with a GP or pharmacist is sensible after years of treatment.

Who Should Not Stop

This is the part most easily lost in a story about getting people off medication. Some people are not taking a PPI because they once had heartburn.

NICE recommends long-term full-dose treatment for severe oesophagitis, and the same for people who have had an oesophageal stricture dilated. Specialist guidance adds Barrett's oesophagus and complicated reflux disease, including oesophageal ulcers, to the list of situations where withdrawal should not routinely be considered.

Then there is a group whose PPI has nothing to do with reflux at all. NSAIDs, antiplatelets and some other medicines raise the risk of ulcers and bleeding, and a PPI is prescribed to protect against that. The AGA's advice is explicit: patients at high risk of upper gastrointestinal bleeding should not be considered for deprescribing. Stopping on the grounds that you have no heartburn would misunderstand why the drug was prescribed, which is why deprescribing guidance recommends assessing bleeding risk before withdrawing anything.

Who Might Be Able to Reduce or Stop

At the other end are people whose PPI began as a short course for uncomplicated reflux or dyspepsia, whose symptoms settled long ago and whose repeat prescription has simply continued. Those are the prescriptions worth revisiting.

NICE recommends stepping down to the lowest dose that controls symptoms and discussing as-needed use. The AGA's clinical practice update goes further: everyone on a PPI should have their indication reviewed periodically and documented, those without a definitive indication should be considered for deprescribing, and most people on twice-daily treatment who still have an indication can be considered for a step down to once daily.

Its final piece of advice is the one that should govern this whole conversation. The decision to stop should be based solely on the lack of an indication, and not on concern about PPI-associated adverse events. Having experienced one of those events, or having risk factors for one, is not in itself a reason to withdraw the drug. That is a considerably more useful rule than deciding everyone should come off omeprazole as quickly as possible.

What This Actually Means

Dr Kaye's warning contains a real point, but "get off PPIs" is too broad a rule to be useful. Long-term treatment should not roll on indefinitely because nobody has reconsidered it, and both NICE and specialist guidance support checking whether an indication still exists. The opposite mistake is just as possible, because the growing list of diseases associated with PPIs in observational research makes these medicines sound more dangerous than the strongest evidence supports, and the one large randomised trial found almost nothing over three years. So the question for someone who has been taking omeprazole for months or years is not how quickly they can stop. It is why they are still taking it. If the answer is no longer clear, that is a good reason to book a review. If the answer is severe oesophageal disease or protection against bleeding, continuing may be considerably safer than stopping.

Frequently Asked Questions

Is it bad to take omeprazole every day?

Not necessarily. Some people have clear clinical reasons to take one daily for long periods, though treatment should be reviewed periodically so the dose, benefit and indication remain clear.

Does omeprazole cause dementia?

Current research does not establish that it does. Observational studies have produced conflicting results, and recent reviews have found no consistent overall association, with one umbrella review concluding that a causal relationship appears unlikely.

Can omeprazole damage your kidneys?

PPIs can rarely cause acute interstitial nephritis. Observational studies have also linked long-term use with chronic kidney disease, but those studies cannot establish that PPIs are responsible, and the randomised evidence over three years found no increase.

What happens if I suddenly stop omeprazole?

Some people get temporary acid symptoms because of rebound acid hypersecretion, which can look like the original reflux returning. Anyone on long-term treatment should discuss stopping or reducing it with a GP or pharmacist.

Should I taper omeprazole?

Tapering is used in some NHS deprescribing protocols, mainly to manage rebound symptoms, but specialist guidance says either gradual reduction or abrupt discontinuation can be considered, because the evidence does not establish a single best method.

Who should not stop a PPI without medical advice?

People taking one for severe or complicated reflux disease, Barrett's oesophagus, an oesophageal stricture, previous ulcer complications, or protection against gastrointestinal bleeding. If you do not know why yours was prescribed, establish that before changing anything.

The Bottom Line

The problem with PPIs is not simply that people take them for too long. It is that nobody has checked whether the reason for taking them still exists. For uncomplicated reflux that has settled, reducing the dose, moving to occasional use or stopping may well be appropriate, and rebound acid is a reason to plan that properly rather than to avoid it.

For other people, long-term acid suppression has a clear protective purpose, and the evidence that it is quietly causing harm is weaker than the headlines suggest. The sensible target is not long-term PPI use. It is long-term PPI use without a continuing reason.

This article is for general information and does not replace individual medical advice. Do not stop a prescribed PPI without discussing with your doctor or pharmacist why you take it and whether stopping is safe.