Effects of omeprazole or anti-reflux surgery on lower oesophageal sphincter characteristics and oesophageal acid exposure over 10 years.
OBJECTIVE
To compare the effect of anti-reflux surgery (ARS) versus proton pump inhibitor therapy on lower oesophageal sphincter (LOS) function and oesophageal acid exposure in patients with chronic gastro-oesophageal reflux disease (GORD) over a decade of follow-up.


METHODS
In this randomised, prospective, multicentre study we compared LOS pressure profiles, as well as oesophageal exposure to acid, at baseline and at 1 and 10 years after randomisation to either open ARS (n = 137) or long-term treatment with omeprazole (OME) 20-60 mg daily (n = 108).


RESULTS
Median LOS resting pressure and abdominal length increased significantly and remained elevated in patients operated on with ARS, as opposed to those on OME. The proportion of total time (%) with oesophageal pH <4.0 decreased significantly in both the surgical and medical groups, and was significantly lower after 1 year in patients treated with ARS versus OME. After 10 years, oesophageal acid exposure was normalised in both groups, with no significant differences, and bilirubin exposure was within normal limits. After 10 years, patients with or without Barrett's oesophagus did not differ in acid reflux control between the two treatment options.


CONCLUSIONS
Open ARS and OME were both effective in normalising acid reflux into the oesophagus even when studied over a period of 10 years. Anatomically and functionally the LOS was repaired durably by surgery, with increased resting pressure and abdominal length.
a Department of Medicine , Haukeland University Hospital , Bergen , Norway.
Birgitte-Elise G
BG
Emken
b Department of Surgery , Centre for Digestive Diseases, Karolinska University Hospital, CLINTEC, Karolinska Institutet , Stockholm , Sweden.
Lars R
LR
Lundell
c Department of Surgery , Glostrup University Hospital , Copenhagen , Denmark.
Lene
L
Wallin
d Department of Cancer Research and Molecular Medicine , Norwegian University of Science and Technology , Trondheim , Norway.
Helge E
HE
Myrvold
e Department of Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden.
Cecilia
C
Engström
f Department of Surgery , Ersta Hospital , Stockholm , Sweden.
Madeleine
M
Montgomery
g Formerly of AstraZeneca Gothenburg , Mölndal , Sweden.
Anders R
AR
Malm
g Formerly of AstraZeneca Gothenburg , Mölndal , Sweden.
Tore
T
Lind
a Department of Medicine , Haukeland University Hospital , Bergen , Norway.
Jan G
JG
Hatlebakk
D000368:Aged; D001471:Barrett Esophagus / Q000601:surgery / Q000628:therapy*; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology*; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000601:surgery / Q000628:therapy*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D013514:Surgical Procedures, Operative; D016896:Treatment Outcome
D054328:Proton Pump Inhibitors; D009853:Omeprazole
Barrett's oesophagus; bilirubin; fundoplication; gastric acidity determination; gastroesophageal reflux; lower; manometry; oesophageal sphincter; omeprazole; proton pump inhibitors