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Long-term outcome of microscopic esophagitis in chronic GERD patients treated with esomeprazole or laparoscopic antireflux surgery in the LOTUS trial.
Long-term outcome of microscopic esophagitis in chronic GERD patients treated with esomeprazole or laparoscopic antireflux surgery in the LOTUS trial.
- Source :
-
The American journal of gastroenterology [Am J Gastroenterol] 2010 May; Vol. 105 (5), pp. 1015-23. Date of Electronic Publication: 2009 Nov 10. - Publication Year :
- 2010
-
Abstract
- Objectives: Gastroesophageal reflux disease (GERD)-associated changes in esophageal histology have been reported mainly after short-term medical antireflux therapy, and few individual lesions have been examined. We report detailed histological findings from the LOTUS study, at baseline and at 1 and 3 years after laparoscopic antireflux surgery (LARS) or esomeprazole treatment in patients with chronic GERD.<br />Methods: LOTUS is a long-term, open, parallel-group, multicenter, randomized, controlled trial conducted in 11 European countries that compared LARS (n=248) with esomeprazole 20-40 mg daily (n=266). Biopsies from the distal esophagus 2 cm above the Z-line and at the Z-line were taken at baseline, and 1 and 3 years. The following lesions were assessed: basal cell hyperplasia (BCH), papillary elongation (PE), intercellular space dilatations (ISDs), intraepithelial eosinophils (EOSs), neutrophils, and necrosis/erosion. A severity score (SS, range 0-2) was calculated by taking the average score of all assessable lesions.<br />Results: All lesions were more severe on Z-line biopsies than at 2 cm, and almost all improved significantly from baseline to 1 and 3 years. The average SS (from 2 cm to Z-line) changed from 0.95 to 0.57 (1 year) and to 0.49 (3 years) on esomeprazole, and from 0.91 to 0.56 (1 year) and to 0.52 (3 years) after LARS (P<0.001 for both treatments at 1 and 3 years, with no significant difference between treatments). The proportions of patients with severe histological changes decreased from approximately 50% at baseline to 11% at 3 years.<br />Conclusions: Both continuous esomeprazole treatment and laparoscopic fundoplication are associated with significant and similar overall improvement in microscopic esophagitis after 1 year that is maintained at 3 years.
- Subjects :
- Adult
Age Distribution
Biopsy, Needle
Chronic Disease
Esomeprazole administration & dosage
Esophageal pH Monitoring
Esophagitis, Peptic epidemiology
Esophagoscopy methods
Female
Follow-Up Studies
Fundoplication methods
Gastroesophageal Reflux diagnosis
Humans
Immunohistochemistry
Incidence
Kaplan-Meier Estimate
Male
Middle Aged
Probability
Risk Assessment
Severity of Illness Index
Sex Distribution
Statistics, Nonparametric
Time Factors
Treatment Outcome
Esomeprazole adverse effects
Esophagitis, Peptic etiology
Esophagitis, Peptic pathology
Fundoplication adverse effects
Gastroesophageal Reflux drug therapy
Gastroesophageal Reflux surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1572-0241
- Volume :
- 105
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- The American journal of gastroenterology
- Publication Type :
- Academic Journal
- Accession number :
- 19904246
- Full Text :
- https://doi.org/10.1038/ajg.2009.631