Figure 5  .

Hierarchy of the efficacy of primary drug treatments, which should be used to guide the choice of step down (or step up) therapy. Drug costs within the applicable practice setting should also guide the choice of step down therapy. Combination H₂ receptor antagonist (H₂RA) and cisapride therapy are not included as primary therapies, in the light of discussion and voting on statements 51 and 52. Because of the lack of evidence of useful benefit from double dose H₂ receptor antagonist and cisapride (see statements 49 and 50) this option has not been included as a mainstream step. PPI, proton pump inhibitor.