 Step-down therapy: Step-down subjects discontinued PPIs and were prescribed histamine2-receptor antagonists H2RAs for 2 weeks, and if still asymptomatic, H2RAs were discontinued. If symptoms recurred, H2RAs were reinitiated, and if still symptomatic, subjects were prescribed PPIs at the dose that initially alleviated their symptoms. Intermittent therapy: Intermittent therapy subjects discontinued daily use of PPIs and were prescribed short courses of PPI daily for 8 weeks for recurrence of GERD symptoms. The primary efficacy measure was the proportion of subjects remaining free of GERD symptoms while on their prescribed therapy step-down group: no symptoms on H2RAs or no GERD medication; intermittent therapy group: no PPIs for 2 weeks after discontinuation, and 3 symptom recurrences requiring PPIs; control groups: no GERD symptoms on PPI. Follow up was conducted for 6 months after randomization. In addition to the primary efficacy measure, we examined total resource utilization pharmacy and non-pharmacy, HRQOL, and potential predictors of non-response to step-down or intermittent therapy requirement of daily PPI to control symptoms. Logistic regression and random-effects models adjusted for covariates and clustering effects. 