Table 1.

Rational short- and long-term use of PPI

Duration	Reason for treatment [7, 11, 18, 19]
Short-term therapy (4–8 weeks)	Low-grade (LA A, Ba) oesophagitis
	Uncomplicated H. pylori infection treated for 2 weeks (in conjunction with antibiotics)
	Reflux-like symptoms of sufficient magnitude and/or frequency to impair QoL
	Dyspepsiab of sufficient magnitude and/or frequency to impair QoL
	Stress ulcer prophylaxis in an intensive care unit
Long-term therapy (>8 weeks, maintenance)	High-grade (LA C, D) oesophagitis or peptic stricture
	Zollinger-Ellison syndrome
	Barrett’s oesophagus (endoscopic tongue or segment >1 cm with intestinal metaplasia)
	Eosinophilic oesophagitis
	Prior bleeding gastric or duodenal ulcer (H. pylori negative)
	Idiopathic pulmonary fibrosis
	Chronic use of NSAIDs with moderate to high bleeding risk (age >65 years, high-dose NSAIDs, prior ulcer, concomitant corticosteroids, antiplatelet meds, significant renal disease)
	Prior unsuccessful attempt to reduce or discontinue because of recurrent upper gastrointestinal symptoms that impair QoL (despite utilization of a strategy that accounts for potential rebound hypersecretion)
	Co-administration with digestive enzyme replacement for chronic pancreatitis

H. pylori, Helicobacter pylori; LA, The Los Angeles classification of erosive oesophagitis; NSAIDs, nonsteroidal anti-inflammatory drugs; QoL, quality of life.

^aLA grade A is mild; LA grade C and D are severe; healthcare provider discretion is required for LA grade B classification, which covers a range of severity, meaning that some patients may require longer term PPI. The revised Lyon Consensus for the diagnosis of GORD, contrary to the original [20], states that well-characterized LA grade B oesophagitis represents conclusive evidence for GORD and a similar acid exposure time to LA grade C [21].

^bPatients with uninvestigated dyspepsia should be tested for H. pylori infection and treated if positive [29].