Medical or surgical management of GERD patients with Barrett's esophagus: the LOTUS trial 3-year experience.
BACKGROUND
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.


CONCLUSIONS
In a well-controlled surgical environment, the success of LARS is similar in patients with or without BE and matches optimized medical therapy.
Attwood
S E
SE
North Tyneside Hospital, North Shields, UK. Stephen.Attwood@NHCT.nhs.uk
Lundell
L
L
Hatlebakk
J G
JG
Eklund
S
S
Junghard
O
O
Galmiche
J-P
JP
Ell
C
C
Fiocca
R
R
Lind
T
T
D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001471:Barrett Esophagus / Q000209:etiology / Q000628:therapy*; D064098:Esomeprazole / Q000627:therapeutic use*; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications / Q000628:therapy*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged
D000897:Anti-Ulcer Agents; D064098:Esomeprazole