OBJECTIVES: Gastroesophageal refl ux disease (GERD)-associated changes in esophageal histology have been reported mainly after short-term medical antirefl ux therapy, and few individual lesions have been examined. We report detailed histological fi ndings from the LOTUS study, at baseline and at 1 and 3 years after laparoscopic antirefl ux surgery (LARS) or esomeprazole treatment in patients with chronic GERD. 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. RESULTS: All lesions were more severe on Z-line biopsies than at 2 cm, and almost all improved signifi cantly 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 signifi cant difference between treatments). The proportions of patients with severe histological changes decreased from approximately 50 % at baseline to 11 % at 3 years. CONCLUSIONS: Both continuous esomeprazole treatment and laparoscopic fundoplication are associated with signifi cant and similar overall improvement in microscopic esophagitis after 1 year that is maintained at 3 years.
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|Titolo:||Long-term outcome of microscopic esophagitis in chronic GERD patients treated with esomeprazole or laparoscopic anti-reflux surgery, in the LOTUS trial.|
|Data di pubblicazione:||2010|
|Appare nelle tipologie:||01.01 - Articolo su rivista|