Chronic Gastroesophageal Reflux Disease - Medication And Surgery Equally Effective

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Academic Journal
Main Category: Acid Reflux / GERD
Also Included In: GastroIntestinal / Gastroenterology
Article Date: 18 May 2011 - 6:00 PDT

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Laparoscopic antireflux surgery or taking proton pump inhibitor esomeprazole for chronic GERD (chronic gastroesophageal reflux disease) were both found to result in similar rates of disease remission of five years, researchers from Nantes University, France, reported in JAMA (Journal of the American Medical Association).

As background information, the authors wrote:

"GERD is a highly prevalent disorder caused by the reflux of gastric contents into the esophagus. It is a chronic, relapsing disease that negatively affects patients' health-related quality of life and reduces work productivity."

There are two treatment options for GERD:

• Long term drug therapy, as with a PPI (proton pump inhibitor)
• Laparoscopic antireflux surgery (LARS)

Patients who do not want to be on medication long term may prefer to opt for antireflux surgery. The authors explained that few studies have compared LARS with long-term drug therapy.

Jean-Paul Galmiche, M.D., F.R.C.P. and team set out to compare PPI esomeprazole (dose-adjusted when required) with standardized LARS in GERD patients who had responded well to acid-suppressive therapy.

They performed a 5-year randomized trial in 11 European countries between October 2001 and April 2009, involving 554 patients. 372 of them completed the 5-year follow up. Of the 372, 192 were given esomeprazole (20 to 40 mg/d, allowing for dose adjustments) and 180 underwent LARS.

The study's main focus (primary outcome) was to measure how long it took for treatment to stop working. In the case of LARS, how long till the patient required acid suppressive therapy, and for esomeprazole, inadequate symptom control after adjusting dosages.

Brand name examples of esomeprazole include: Sompraz, Zoleri, Nexium, Lucen, Esopral; Axagon in Italy, and Nexiam in Belgium and South Africa.

After five years, the researchers found that:

• 85% of the LARS patients remained in remission
• 92% of the esomeprazole patients remained in remission

Heartburn and acid regurgitation symptoms in the LARS group decreased after randomization, while showing similar levels in the esomeprazole group.

The researchers wrote:

"At 5 years, acid regurgitation was significantly worse in the esomeprazole group than in the LARS group (13% vs. 2%, respectively), although there was no significant difference between the groups in the severity of heartburn (16% vs. 8%), epigastric [an area of the abdomen] pain (18% vs. 18%), or diarrhea (15% vs. 16%). At 5 years, dysphagia [difficulty swallowing] remained significantly more common in the LARS group than in the esomeprazole group (11% vs. 5%, respectively), as did bloating (40% vs. 28%, respectively) and flatulence (57% vs. 40%, respectively)."

28.6% of the LARS patients reported adverse events over five years, a similar number to the 24.1% in the esomeprazole group.

The authors concluded:

"This large, multicenter randomized trial demonstrated that with modern forms of antireflux therapy, either by drug-induced acid suppression or after LARS, most patients remain in remission for at least 5 years."

"Laparoscopic Antireflux Surgery vs Esomeprazole Treatment for Chronic GERD - The LOTUS Randomized Clinical Trial"
Jean-Paul Galmiche, MD, FRCP; Jan Hatlebakk, MD, PhD; Stephen Attwood, MD, PhD; Christian Ell, MD, PhD; Roberto Fiocca, MD, PhD; Stefan Eklund, MD, PhD; Göran Långström, PhD; Tore Lind, MD, PhD; Lars Lundell, MD, PhD
JAMA. 2011;305(19):1969-1977. doi: 10.1001/jama.2011.626

Written by Christian Nordqvist


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