OBJECTIVES: PPIs are commonly used for GERD treatment, a condition characterized by heartburn and acid reflux symptoms.  This study aimed to describe prescribing patterns, healthcare resource utilization, and PPI costs in a nationally representative sample of GERD patients. METHODS: A nationally representative chart review and patient/physician survey was conducted in GERD patients currently taking a prescription PPI (esomeprazole-ESO, lansoprazole-LAN, omeprazole-OME, dexlansoprazole-DEX, rabeprazole-RAB, pantoprazole-PAN).  Physicians reported their prescribing patterns in the past 6 months.  Patient prescription information and rationale for prescribing were also collected from charts.  Annual PPI cost was calculated by multiplying Red Book AWP by reported dose per day x 365.25. RESULTS: 252 physicians [74 gastroenterologists (GEs), 178 primary care physicians (PCP)] and 501 patients (94 ESO, 74 LAN, 94 OME, 94 DEX, 75 PAN, 70 RAB) were included in the study. Patients were 51 years old on average, 37% male, with 16% erosive versus 56% symptomatic GERD (28% undocumented).  Physicians reported most frequently prescribing OME (26.4% of their patients), with GEs more likely to prescribe DEX (PCP 11%/GE 19%, p<0.001) and RAB (PCP 9%/GE 13%, p<0.01) and PCPs more likely to prescribe H2 blockers (PCP 12%/GE 7%).  DEX was the only PPI not prescribed twice daily. 8%(PAN)-20%(OME) of other PPIs were used twice daily.  Moreover, all DEX patients were prescribed labeled doses, in contrast with other PPIs prescribed at doses higher than labeled [6%(ESO)-37%(OME)].  Average annual PPI costs ranged from $1600(DEX)-$3000(RAB), p<0.001. There were no significant differences in GERD-related hospitalizations, emergency room visits, or physician visits across PPIs. CONCLUSIONS: Prescribing patterns varied greatly across PPIs.  While all included PPIs are labeled for once daily use, DEX was observed as the only PPI prescribed in full accord with the labeled doses and not prescribed twice daily in our cohort. It also incurred lower medication costs compared to other PPIs.