Long-term outcome of microscopic esophagitis in chronic gerd patients treated with esomeprazole or laparoscopic antireflux surgery in the lotus trial

Roberto Fiocca, Luca Mastracci, Cecilia Engström, Stephen Attwood, Christian Ell, Jean Paul Galmiche, Jan Hatlebakk, Ola Junghard, Tore Lind, Lars Lundell

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVES: Gastroesophageal reflux disease (GERD)-associated changes in esophageal histology have been reported mainly after short-term medical antireflux therapy, and few individual lesions have been examined. We report detailed histological findings from the LOTUS study, at baseline and at 1 and 3 years after laparoscopic antireflux surgery (LARS) or esomeprazole treatment in patients with chronic GERD.METHODS: LOTUS is a long-term, open, parallel-group, multicenter, randomized, controlled trial conducted in 11 European countries that compared LARS (n248) with esomeprazole 20-40 mg daily (n266). Biopsies from the distal esophagus 2 cm above the Z-line and at the Z-line were taken at baseline, and 1 and 3 years. The following lesions were assessed: basal cell hyperplasia (BCH), papillary elongation (PE), intercellular space dilatations (ISDs), intraepithelial eosinophils (EOSs), neutrophils, and necrosis/erosion. A severity score (SS, range 0-2) was calculated by taking the average score of all assessable lesions.RESULTS: All lesions were more severe on Z-line biopsies than at 2 cm, and almost all improved significantly from baseline to 1 and 3 years. The average SS (from 2 cm to Z-line) changed from 0.95 to 0.57 (1 year) and to 0.49 (3 years) on esomeprazole, and from 0.91 to 0.56 (1 year) and to 0.52 (3 years) after LARS (P0.001 for both treatments at 1 and 3 years, with no significant difference between treatments). The proportions of patients with severe histological changes decreased from approximately 50% at baseline to 11% at 3 years.CONCLUSIONS: Both continuous esomeprazole treatment and laparoscopic fundoplication are associated with significant and similar overall improvement in microscopic esophagitis after 1 year that is maintained at 3 years.

Original languageEnglish
Pages (from-to)1015-1023
Number of pages9
JournalAmerican Journal of Gastroenterology
Volume105
Issue number5
DOIs
Publication statusPublished - May 2010

ASJC Scopus subject areas

  • Gastroenterology

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