Table 2.

Major factors driving PPI overuse

Healthcare professionals	Patients
Timesaving (vs. lifestyle counselling)	Desire for simple, easy solution; minimal effort
Over-diagnosis of “GORD” on a clinical basis	Lack of proper and timely review of prescription
Misconceptions regarding “refractory GORD”	Misconception that PPIs are curative
Unnecessary continuation of hospital-initiated prescriptions	Belief that reflux-like symptoms are caused by excessive acid
Limited access to investigations and/or secondary care	Reluctance or failure to modify behaviour
Limited alternative therapies	Ease of access to PPIs in the pharmacy
Belief that all reflux-like symptoms are caused by acid reflux	Poor understanding of alternative therapeutic options
ENT-initiated for suspected reflux syndrome without a long-term plan
Missing information in electronic patient records regarding indication

ENT, ear, nose, and throat department; GORD, gastro-oesophageal reflux disease; PPI, proton pump inhibitor.