Abstract : Proton pump inhibitors are among the most prescribed drugs in Belgium, due to the high prevalence of gastrooesophageal reflux disease and significant impairment of health-related well-being. Short-term and long-term efficacy is superior to that of H2-receptor antagonists. Long-term safety is established. Empirical short-term treatment of symptomatic patients under 50 years of age without alarm signs is acceptable, but endoscopic investigation should always be performed before starting a long-term treatment. Doses for management of low-grade oesophagitis may be tailored to the patient’s response. Continuous maintenance of full-dose is recommended for high grade oesophagitis. Surgical alternative is to be discussed with patients. Efficacy and mean cost for insurance plans are comparable. Endoscopic procedures are not yet sufficiently evaluated to be considered. Simple lifestyle advice is still useful. The burden of proton pump inhibitors cost is acceptable if they are prescribed at adequate doses. Cost-effective drugs should be chosen first.