Esomeprazole vs. laparoscopic antireflux sugery

January 01, 0001

Esomeprazole vs. laparoscopic antireflux sugery

Gastroesophageal reflux disease (GERD) is a common condition seen in primary care and can be chronic. These European researchers compared the efficacy of esomeprazole therapy vs laparoscopic antireflux surgery (LARS) for treating GERD. They performed a 5-year exploratory randomized, open, parallel- group trial (the LOTUS trial), enrolling patients with chronic GERD (n=554). Patients were randomized to either optimized esomeprazole therapy or LARS. Outcomes were analyzed with the Kaplan-Meier method.

The researchers found: "Estimated remission rates at 5 years were 92% in the esomeprazole group and 85% in the LARS group. The difference between groups was no longer statistically significant following best-case scenario modeling of the effects of study dropout. The prevalence and severity of symptoms at 5 years in the esomeprazole and LARS groups, respectively, were 16% and 8% for heartburn, 13% and 2% for acid regurgitation, 5% and 11% for dysphagia, 28% and 40% for bloating, and 40% and 57% for flatulence. Mortality during the study was low (4 deaths in the esomeprazole group and 1 death in the LARS group) and not attributed to treatment, and the percentages of patients reporting serious adverse events were similar in the esomeprazole group (24.1%) and in the LARS group (28.6%)."

The researchers concluded: "This multicenter clinical trial demonstrated that with contemporary antireflux therapy for GERD, either by drug-induced acid suppression with esomeprazole or by LARS, most patients achieve and remain in remission at 5 years."

Medical therapy and surgery were equally effective at controlling chronic GERD symptoms


For the full abstract, click here.

JAMA 305(19):1969-1977, 18 May 2011
© 2011 American Medical Association
Laparoscopic Antireflux Surgery vs Esomeprazole Treatment for Chronic GERD. Jean-Paul Galmiche, Jan Hatlebakk, Stephen Attwood, et al.

Category: D. Digestive. Keywords: GERD, reflux, esomeprazole, laparoscopic antireflux surgery, proton pump inhibitor, randomized trial, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 10 June 2011

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