Gut Health and Drug Costs

In 2025, problems with the gut-like inflammatory bowel disease (IBD) and acid reflux-are more common than ever, and the costs of treating them are soaring. These conditions don’t just affect people’s day-to-day lives-they’re also putting a serious financial strain on the NHS.

Whether it’s high-priced biologic drugs for severe cases of Crohn’s or ulcerative colitis, or the mass use of cheap but widely prescribed antacid medications like omeprazole, the NHS is trying to manage both high-cost, low-volume treatments and low-cost, high-volume prescriptions.

What Are IBD and GORD?

First, a quick recap:

• Inflammatory Bowel Disease (IBD) includes two main conditions: Crohn’s disease and ulcerative colitis. These are long-term illnesses where parts of the gut become inflamed, often causing pain, diarrhoea, fatigue, and weight loss.
• Gastro-oesophageal reflux disease (GORD) is a common condition where acid from the stomach leaks up into the food pipe, causing heartburn and indigestion.

Though very different in severity, both conditions are incredibly common and often need long-term medication.

The High Cost of IBD: Biologics on the Rise

For people with moderate to severe IBD, biologic drugs are now the go-to treatment. These are advanced medicines made from living cells and are often given by injection or drip. The main drugs used include:

• Adalimumab
• Ustekinumab
• Vedolizumab

These treatments are highly effective, especially for people who haven’t responded to standard therapies. They help reduce inflammation, prevent flares, and improve quality of life. However, they come at a steep cost.

In 2025, the NHS is estimated to spend over £800 million each year on biologic drugs for IBD alone. ¹

Even though some older drugs like adalimumab now have cheaper “biosimilar” versions available (essentially generic biologics), newer drugs like ustekinumab and vedolizumab are still very expensive-costing over £10,000 per person per year. ⁵

The growing use of biologics is partly due to:

• Better early diagnosis of IBD
• Broader treatment guidelines from NICE ²
• Increased awareness of gut health and treatment options

In short, more people are being diagnosed earlier and treated more aggressively-which is great for patient outcomes but expensive for the NHS.

At the Other End: PPIs and the Cost of Acid Reflux

While biologics are expensive and used by relatively few people, the opposite is true for proton pump inhibitors (PPIs)-medications like:

• Omeprazole
• Lansoprazole
• Esomeprazole

These drugs are cheap, widely available, and incredibly common. In fact, PPIs are among the top five most prescribed medications in the UK. ⁶

They’re mainly used to treat:

• GORD (acid reflux)
• Stomach ulcers
• Indigestion

Even though a single tablet can cost pennies, the NHS spends over £100 million per year on PPIs due to the massive number of prescriptions. ⁷

Are PPIs Being Overprescribed?

Yes-and this is becoming a growing concern. Although PPIs are effective and usually safe, many people:

• Stay on them for years without review
• Take them “just in case”
• Don’t need them long-term

According to NICE guidelines, PPIs should be reviewed regularly and stopped if they’re no longer necessary. ⁸ But patients end up on repeat prescriptions, and this is often where the concern is. 

Long-term use has been linked to possible health risks, such as:

• Low calcium and magnesium levels
• Vitamin B12 deficiency
• Osteoporosis
• Increased risk of bone fractures and kidney issues ⁹

This has led experts to call for better deprescribing practices-reviewing and stopping unnecessary medications to avoid harm and cut costs.

The Bigger Picture: A Two-Sided Cost Challenge

The NHS faces a two-sided gut health challenge:

1. Biologic drugs are expensive but essential for people with severe IBD. The challenge is managing their cost while ensuring those who need them can access them.
2. PPIs are cheap per dose but extremely common. The challenge is reducing unnecessary use while keeping effective care available.

Together, these two groups of drugs cost the NHS nearly £1 billion per year-and the figure is still climbing.

What This Means for Patients and Physiotherapists

For patients, these medications can be life-changing. But they’re not without side effects or long-term implications:

• People with IBD often suffer from joint pain, fatigue, or reduced bone strength, which can impact physical activity.
• Long-term PPI users may experience nutrient absorption issues or bone weakness, which can delay recovery from injuries or surgery.

That’s where physiotherapists come in. Understanding what medications patients are on-and how those drugs affect things like strength, bone health, or energy levels-can help tailor rehab programmes more effectively.

For example:

• A patient with Crohn’s disease and hip pain might need modified exercises due to underlying inflammation.
• Someone on PPIs for years might benefit from bone-loading activities to counteract potential loss in bone density.

Looking Ahead: Improving our gut health and microbiome

As gut-related conditions become more common, we need to focus far more on our health and healthy eating:

The key solution is to reduce bad foods, eat a more balanced diet, and improve personalised care. We need to eat less and exercise more. This will help reduce problems with our gut and tummy. 

The NHS also needs to step up. For example, I know many GPs who keep prescribing PPIs for patients and simply put them on repeat prescription. This is not acceptable. Patients should be reviewed, but the problem may not be with the GP, per se, but with the demand on the system. 

Public awareness is also key. Patients should feel empowered to ask:

• Do I still need this medication?
• Are there side effects I should know about?
• What else can I do to manage my condition?

Balancing Cost, Care, and Common Sense

In 2025, treating gut health conditions means more than just writing a prescription. For IBD, the NHS is investing in breakthrough treatments-but at a cost. For acid reflux and indigestion, it's trying to rein in years of routine prescribing.

As new drugs arrive and older ones come under review, smart prescribing, interdisciplinary care, and patient education will be essential to keeping both people and the NHS healthy.

References

1. NHS Business Services Authority. Prescription Cost Analysis – England 2024/25. NHSBSA; 2025.
   
2. NICE. Management of Crohn’s disease and ulcerative colitis. Clinical Guidelines CG152 and CG166; updated 2023.
   
3. The King’s Fund. Biologic medicines and biosimilars: How the NHS is managing competition. 2024.
   
4. British Society of Gastroenterology. IBD Biologics and Small Molecules Position Statement. 2024.
   
5. NICE. Ustekinumab for ulcerative colitis. TA633; 2020.
   
6. NHSBSA. Top 100 Prescribed Items by Volume – England 2024.
   
7. OpenPrescribing.net. PPI class drug spending trends. 
   
8. NICE. Gastro-oesophageal reflux disease: Clinical Guideline CG184; 2019 (updated 2023).
   
9. Freedberg, D.E., et al. Long-term use of PPIs and health outcomes. JAMA Intern Med. 2017;177(2):172–179.