OBJECTIVES: To document the costs, practice patterns, patient satisfaction, and quality of life associated with treating GERD in a managed care population. METHODS: This intent-to-treat study employed data from two medical groups associated with a federally-qualified HMO in California. Patients with encounters for IDC-9 codes: 530.00 to 530.99 (esophagus), 535.00 to 535.99 (gastritis) and 553.3 (diaphragmatic hernia) were included. 349 patients identified as beginning a new GI treatment episode between 03/01/97 and 08/31/97 were sent a survey containing the MOS SF-12 instrument and ABIM patient satisfaction survey (score range 0-50) shortly after beginning their episode. Patients were resurveyed 8 weeks later. RESULTS: Surveyed patients ranged in age from 24-95 years and 58% were female. Cimetidine (59%=123/207) was the most common H2-receptor antagonist (H2RA) monotherapy prescribed followed by Ranitidine (29%=60/207). Omeprazole (99%=105/106) was the most commonly prescribed proton-pump inhibitor (PPI) monotherapy. Treatment episode lengths, time since previous episode, and time until subsequent episode were not significantly different for those initiating treatment on H2RA vs. PPI monotherapy. No significant changes in baseline vs. follow-up SF-12 (baseline mean PCS=43.7, MCS=49.8) and ABIM patient satisfaction (baseline median=44) were observed (n=103 respondents). Total episode cost among respondents differed significantly (p=0.02) between H2RAs (median=$84) vs. PPIs (median=$169). CONCLUSIONS: This study was not able to detect differences in the patient satisfaction and quality of life in H2RA vs. PPI monotherapy in this population. As expected, episode costs were higher for PPIs vs. H2RAs (primarily due to medication costs).