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

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.