Comparing laparoscopic antireflux surgery with esomeprazole in the management of patients with chronic gastro-oesophageal reflux disease: a 3-year interim analysis of the LOTUS trial

• Published in: Gut Vol. 57; no. 9; pp. 1207 - 1213
• Main Authors: Lundell, L, Attwood, S, Ell, C, Fiocca, R, Galmiche, J-P, Hatlebakk, J, Lind, T, Junghard, O
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.09.2008; BMJ; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Acids; Adult; Anti-Ulcer Agents - adverse effects; Anti-Ulcer Agents - therapeutic use; Biological and medical sciences; Biopsy; Chronic Disease; Digestive system; Endoscopy; Esomeprazole - adverse effects; Esomeprazole - therapeutic use; Esophagus; Female; Fundoplication - adverse effects; Fundoplication - methods; Gastro-Oesophageal Reflux; Gastroenterology. Liver. Pancreas. Abdomen; Gastroesophageal Reflux - drug therapy; Gastroesophageal Reflux - surgery; Humans; Laparoscopy; Laparoscopy - adverse effects; Laparoscopy - methods; Male; Medical sciences; Medical treatment; Medicin och hälsovetenskap; Middle Aged; Other diseases. Semiology; Pharmacology. Drug treatments; Quality of Life; Severity of Illness Index; Surgery; Surgical outcomes; Treatment Outcome; Human; Gastroesophageal reflux; Enzyme; Chronic disease; Esophageal disease; H; Enzyme inhibitor; Laparoscopic surgery; Antiulcer agent; K; Proton pump inhibitor; Benzimidazole derivatives; Antisecretory agent; Esomeprazole; Gastroenterology; exchanging ATPase; Hydrolases; Digestive diseases
• ISSN: 0017-5749; 1468-3288; 1468-3288
• DOI: 10.1136/gut.2008.148833

Background:With the introduction of laparoscopic antireflux surgery (LARS) for gastro-oesophageal reflux disease (GORD) along with the increasing efficacy of modern medical treatment, a direct comparison is warranted. The 3-year interim results of a randomised study comparing both the efficacy and safety of LARS and esomeprazole (ESO) are reported.Methods:LOTUS is an open, parallel-group multicentre, randomised and controlled trial conducted in dedicated centres in 11 European countries. LARS was completed according to a standardised protocol, comprising a total fundoplication and a crural repair. Medical treatment comprised ESO 20 mg once daily, which could be increased stepwise to 40 mg once daily and then 20 mg twice daily in the case of incomplete GORD control. The primary outcome variable was time to treatment failure (Kaplan–Meier analysis). Treatment failure was defined on the basis of symptomatic relapse requiring treatment beyond that stated in the protocol.Results:554 patients were randomised, of whom 288 were allocated to LARS and 266 to ESO. The two study arms were well matched. The proportions of patients who remained in remission after 3 years were similar for the two therapies: 90% of surgical patients compared with 93% medically treated for the intention to treat population, p = 0.25 (90% vs 95% per protocol). No major unexpected postoperative complications were experienced and ESO was well tolerated. However, postfundoplication complaints remain a problem after LARS.Conclusions:Over the first 3 years of this long-term study, both laparoscopic total fundoplication and continuous ESO treatment were similarly effective and well-tolerated therapeutic strategies for providing effective control of GORD.