Reference : Laparoscopic antireflux surgery vs esomeprazole treatment for chronic GERD: the LOTUS...
Scientific journals : Article
Human health sciences : Gastroenterology & hepatology
Laparoscopic antireflux surgery vs esomeprazole treatment for chronic GERD: the LOTUS randomized clinical trial.
Galmiche, Jean-Paul [> > > >]
Hatlebakk, Jan [> > > >]
Attwood, Stephen [> > > >]
Ell, Christian [> > > >]
Fiocca, Roberto [> > > >]
Eklund, Stefan [> > > >]
Langstrom, Goran [> > > >]
Lind, Tore [> > > >]
Lundell, Lars [> > > >]
Louis, Edouard mailto [Université de Liège - ULiège > Département des sciences cliniques > Hépato-gastroentérologie]
JAMA : Journal of the American Medical Association
American Medical Association
Yes (verified by ORBi)
[en] Adult ; Anti-Ulcer Agents/administration & dosage/adverse effects ; Chronic Disease ; Digestive System Surgical Procedures/adverse effects/methods ; Female ; Gastroesophageal Reflux/drug therapy/surgery ; Humans ; Laparoscopy/adverse effects/methods ; Male ; Middle Aged ; Omeprazole/administration & dosage/adverse effects ; Remission Induction ; Severity of Illness Index ; Treatment Outcome
[en] CONTEXT: Gastroesophageal reflux disease (GERD) is a chronic, relapsing disease with symptoms that have negative effects on daily life. Two treatment options are long-term medication or surgery. OBJECTIVE: To evaluate optimized esomeprazole therapy vs standardized laparoscopic antireflux surgery (LARS) in patients with GERD. DESIGN, SETTING, AND PARTICIPANTS: The LOTUS trial, a 5-year exploratory randomized, open, parallel-group trial conducted in academic hospitals in 11 European countries between October 2001 and April 2009 among 554 patients with well-established chronic GERD who initially responded to acid suppression. A total of 372 patients (esomeprazole, n = 192; LARS, n = 180) completed 5-year follow-up. Interventions Two hundred sixty-six patients were randomly assigned to receive esomeprazole, 20 to 40 mg/d, allowing for dose adjustments; 288 were randomly assigned to undergo LARS, of whom 248 actually underwent the operation. MAIN OUTCOME MEASURE: Time to treatment failure (for LARS, defined as need for acid suppressive therapy; for esomeprazole, inadequate symptom control after dose adjustment), expressed as estimated remission rates and analyzed using the Kaplan-Meier method. RESULTS: Estimated remission rates at 5 years were 92% (95% confidence interval [CI], 89%-96%) in the esomeprazole group and 85% (95% CI, 81%-90%) in the LARS group (log-rank P = .048). 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 (P = .14), 13% and 2% for acid regurgitation (P < .001), 5% and 11% for dysphagia (P < .001), 28% and 40% for bloating (P < .001), and 40% and 57% for flatulence (P < .001). 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%). CONCLUSION: 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. TRIAL REGISTRATION: Identifier: NCT00251927.

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