Proton pump inhibitors are widely used in many upper gastrointestinal disorders. Dyspepsia is a common problem in primary care and endoscopy is neither feasible nor affordable in the majority of patients. Helicobacter pylori eradication has been shown to be effective, but with the declining prevalence of H. pylori infection in Western countries, alternate strategies are necessary. Proton pump inhibitor therapy is one such alternative and has already been adopted in dyspepsia management guidelines in the USA, UK and Canada. Cost-effectiveness studies suggest that in young patients acid suppression alone is more cost-effective than either endoscopy or testing and treatment for H. pylori in areas with a low prevalence of H. pylori.