Continued (5 years) follow-up of a randomised clinical study comparing anti-reflux surgery and omeprazole in gastroesophageal reflux disease

Updated Guidelines for the Diagnosis and Treatment of Gastroesophageal Reflux Disease

“…The long-term outcome of many of these patients reported that after 10 yr, 92% of the patients randomized to medication were still on medications and 62% of those who were initially treated with surgery were now back on reflux medication (112). A trial that randomized 310 patients between surgery and PPIs found surgery to be slightly superior to omeprazole 20 mg per day at the end of 5 yr, but if dose titration up to 40-60 mg per day of omeprazole were used, the two treatments were equal (113). Proper selection and preoperative evaluation of patients is very important.…”

Surgical treatment of gastroesophageal reflux disease: total or partial fundoplication? Systematic review and meta-analysis

“…Open 18 16 180º posterior 2 years Lundell et al (21,22) Hagedorn et al (15) Open 54 56 180º posterior 11 years…”

Surgical Treatment of Gastroesophageal Reflux Disease

“…A large randomized clinical trial from the UK has shown significantly better physiological control of reflux in patients having undergone laparoscopic Nissen fundoplication than patients under maintenance PPI therapy (Laffularde et al 2001). A randomized trial with 5-year follow-up, demonstrated that antireflux surgery is more effective than proton pomp inhibitor (PPI) drugs in controlling GERD symptoms (Laffularde et al 2001;Lundell et al 2001). At 7-years follow-up Lundell et all reported the results of a randomized controlled trial of patients with esophagitis treated with omeprazole or surgery.…”

“…Controversy has surrounded the most appropriate means of reflux control in patients with CLE. While pharmacological acid suppression is the least invasive and most suitable for elderly patients and those with comorbidity, the high incidence of hiatal hernia, lower esophageal sphincter failure, peristaltic impairment, and reflux of duodenal juice renders proton pump inhibitor (PPI) therapy less effective in columnar-lined esophagus than in less severe reflux disease, with up to 40% still demonstrating pathological acid exposure after receiving up to 80 mg per day of omeprazole (Lundell et al 2001;Katzka et al 1994;Sampliner et al 1994;Ouatu-Lascar et al 1998;Sharma et al 1997). Several series have suggested that fundoplication, by virtue of its ability to correct hiatal hernia, lower esophageal sphincter failure, and reflux of duodenal juice, confers some protection against adenocarcinoma development (Wassnaar et al 2010).…”