There are many reasons why people think their PPIs are not working. Here we look at some of them.
Expectation
Those experiencing heartburn who have previously found antacids can provide almost instantaneous relief, may expect PPIs to do the same. - They don't.
PPIs are acid suppressants that reduce the production of stomach acid, rather than neutralising acid already made.
Some may expect PPIs will stop acid reflux and even some doctors think that's what they do, which is their rationale for prescribing them. However, they stop acid not reflux (which needs to be managed by lifestyle).
They may expect to see instant results but, although they start work immediately, two or three days of build up in the system makes them more effective.
Oesophagitis and gastritis won't heal instantly. It can take weeks.
Misuse (see How to Use them.)
If they are to reduce acid must be used before the stomach starts production of it.
Those used to taking antacids may try using them "on demand" when they start feeling symptoms, rather than pre-emptively.
Nocebo effect
Just as real as the placebo effect, if someone believes they won't work, they can persuade themselves they don't.
Insufficiency
Doctors will usually prescribe at the standard maintenance dose. However, if oesophagitis is bad, a higher dose may be needed. (See the chart here.)
This is also required if you are taking any medication that may increase acid production or an NSAID.
Tachyphylaxis
This is the medical term for tolerance.
Many drugs are described as tachyphylaxic meaning that your body starts fetting used to them and you require higher dose to get the same effect. This is similar to drug dependence.
However, PPIs are not tachyphylaxic. Even after years of use, they will continue working just as effectively as they always did, though some users may feel they aren't.
This may be for the following reasons.Â
Complacency
Initially, users are good at ensuring they take their medicines exactly as required and follow the lifestyle guidance to reduce reflux but over time, they may start ignoring the rules.
Worsening symptoms
They may not have been taking them at sufficient dose or may not have been able to control their reflux sufficiently for the PPI to cope.
Dietary changes
Users no longer experiencing heartburn may still have non-symptomatic oesophagitis which can be irritated by certain foods which the person may have recently introduced, or re-introduced, to their diet.
Remember.
PPIs are not a magic wand. They do one job and do it well but you need work with them and to help them do that job.
Page updated 18 June 2025