title: Medical or surgical management of GERD patients with Barrett's esophagus: the LOTUS trial 3-year experience.
abstract: 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.
authors: North Tyneside Hospital, North Shields, UK. Stephen.Attwood@NHCT.nhs.uk
authors: S E
authors: SE
authors: Attwood
authors: L
authors: L
authors: Lundell
authors: J G
authors: JG
authors: Hatlebakk
authors: S
authors: S
authors: Eklund
authors: O
authors: O
authors: Junghard
authors: J-P
authors: JP
authors: Galmiche
authors: C
authors: C
authors: Ell
authors: R
authors: R
authors: Fiocca
authors: T
authors: T
authors: Lind
mesh_terms: 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
chemical_list: D000897:Anti-Ulcer Agents; D064098:Esomeprazole