Table 1.

Patterns of PPI Use Which May be Inappropriate.

Cohort	Definition
Patients for whom PPIs are no longer necessary	- Patients with mild conditions whose treatment lasts longer than 8 weeks. - Patients who have not had their prescription reviewed after 8 weeks, that is, patients receiving treatment for longer than 8 weeks who logged no physician visits in the 8 to 12 weeks after their first PPI prescription for each treatment episode. - Patients using PPI for gastroprotection/prophylaxis who no longer take the comedication—defined as patients receiving overlapping NSAID and PPI treatment for whom the PPI treatment episode ends more than 1 week after the NSAID treatment.
Patients who have been prescribed PPIs inappropriately	- Patients receiving PPIs without an appropriate indication, defined as being one of the gastroesophageal focus diseases. - Patients who received PPI on their first visit for mild disease—meaning patients that for whom a PPI prescription, a diagnosis for one of the mild diseases listed in Table 2, and no severe disease diagnoses are documented upon the first visit. - Patients receiving an interfering co-medication during a PPI treatment episode.
Patients whose PPI dosage can be reduced	- Patients continuously using PPI for longer than 8 weeks. - Patients on high doses PPIs whose dosage remains unchanged in the 8 weeks after the initial prescription. - Patients on polypharmacy (using 5+ concurrent drugs), older patients (age group > 70 years), or patients with impaired liver or kidney function.
Patients with an appropriate PPI prescription	- Patients with at least 1 PPI prescription who were excluded in the 3 previous groups.
Patients who may benefit from an alginate add-on	- Patients who visit the doctor repeatedly during a long PPI episode (defined as patients with an average of 2 or more visits per month after 8 weeks have elapsed since the start of the PPI episode). - Patients who remain on continuous, high-dose PPI for 3 months or longer. - Patients whose daily PPI dose has gone up, suggesting breakthrough symptoms. - Patients with more severe erosive conditions, that is, Barret’s esophagus or Zollinger-Ellison syndrome. - Patients receiving long-term gastroprotection, that is, under NSAID treatments lasting longer than 6 months.
Patients receiving no comedication while reducing or coming off PPI	- Patients who had at least 1 PPI treatment episode whose PPI dosage was reduced during the episode or who received no PPI prescriptions in the 3 months after the end of the treatment episode. Of these, those patients who received no comedication at all during the aforementioned dose reduction or discontinuation episodes were selected for inclusion in this group.