Background: Although widely used, few data are available on the appropriateness of prescribing of acid‐suppressing drugs (ASDs), despite guidelines on the investigation and treatment of dyspeptic patients.Methods: We created a database of 62 000 endoscopy examinations and record‐linked these to a prescribing database. Endoscopic diagnoses were classified into peptic, nonpeptic and others. The H2‐antagonists, omeprazole and misoprostol, were studied.Results: 35 000 patients had one or more endoscopies during 1978–93; two‐thirds were over 45 years of age at first endoscopy. A quarter of all patients who had been endoscoped had consistently normal examinations. Peptic oesophageal pathology was the commonest positive finding. A quarter of those prescribed ASDs between 1989 and 1993 had been endoscoped between 1978 and 1993. In those with a peptic diagnosis prescribed any ASD, the pathologies found were: oesophageal (42.9%), duodenal (36.3%) and gastro‐pyloric (21.3%). Patients prescribed omeprazole were more likely to have undergone endoscopy than those prescribed other ASDs, and they were also more likely to have peptic oesophageal pathology. Long‐term prescribing (>56 days per year) occurred in two‐thirds of patients prescribed ASDs and 40% had at least one endoscopy. In those prescribed short‐term ASDs, 20% had undergone at least one endoscopy. Peptic and nonpeptic endoscopic pathology was associated with increased ASD prescribing, but a normal endoscopy did not reduce prescribing.Conclusion: ASD prescribing appeared to be mainly symptom‐driven. Positive endoscopic findings increased the prescribing of ASDs, but normal findings did not reduce it.