Medical or surgical management of gerd patients with Barrett's esophagus: The LOTUS trial 3-year experience

S. E. Attwood, L. Lundell, J. G. Hatlebakk, S. Eklund, O. Junghard, J. P. Galmiche, C. Ell, R. Fiocca, T. Lind

Research output: Contribution to journalArticle

Abstract

Introduction: The long-term management of gastroesophageal reflux in patients with Barrett's esophagus (BE) is not well supported by an evidence-based consensus. We compare treatment outcome in patients with and without BE submitted to standardized laparoscopic antireflux surgery (LARS) or esomeprazole treatment. Methods: In the Long-Term Usage of Acid Suppression Versus Antireflux Surgery trial (a European multicenter randomized study), LARS was compared with dose-adjusted esomeprazole (20-40 mg daily). Operative difficulty, complications, symptom outcomes [Gastrointestinal Symptom Rating Scale (GSRS) and Quality of Life in Reflux and Dyspepsia (QOLRAD)], and treatment failure at 3 years and pH testing (after 6 months) are reported. Results: Of 554 patients with gastroesophageal reflux disease, 60 had BE-28 randomized to esomeprazole and 32 to LARS. Very few BE patients on either treatment strategy (four of 60) experienced treatment failure during the 3-year follow-up. Esophageal pH in BE patients was significantly better controlled after surgical treatment than after esomeprazole (p=0.002), although mean GSRS and QOLRAD scores were similar for the two therapies at baseline and at 3 years. Although operative difficulty was slightly greater in patients with BE than those without, there was no difference in postoperative complications or level of symptomatic reflux control. Conclusion: In a well-controlled surgical environment, the success of LARS is similar in patients with or without BE and matches optimized medical therapy.

Original languageEnglish
Pages (from-to)1646-1654
Number of pages9
JournalJournal of Gastrointestinal Surgery
Volume12
Issue number10
DOIs
Publication statusPublished - Oct 2008

Keywords

  • Anti-reflux surgery
  • Barrett's esophagus
  • Esomeprazole
  • GERD
  • Laparoscopic fundoplication

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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    Attwood, S. E., Lundell, L., Hatlebakk, J. G., Eklund, S., Junghard, O., Galmiche, J. P., Ell, C., Fiocca, R., & Lind, T. (2008). Medical or surgical management of gerd patients with Barrett's esophagus: The LOTUS trial 3-year experience. Journal of Gastrointestinal Surgery, 12(10), 1646-1654. https://doi.org/10.1007/s11605-008-0645-1