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Randomised controlled trial
Laparoscopic antireflux surgery and esomeprazole similarly efficacious for symptoms in people with gastro-oesophageal reflux disease who respond well to proton pump inhibitors
  1. George Triadafilopoulos
  1. Division of Gastroenterology and Hepatology, Stanford University, Stanford, California, USA
  1. Correspondence to George Triadafilopoulos
    Clinical Professor of Medicine Division of Gastroenterology and Hepatology, Stanford University, School of Medicine, Editor-in-Chief Emeritus, Gastrointestinal Endoscopy, 300 Pasteur Drive, M-211 Stanford, CA 94305, USA; vagt{at}

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Gastro-oesophageal reflux disease (GERD) is a chronic, relapsing condition – manifesting mostly with heartburn and acid regurgitation – that negatively affects daily quality of life. The two main treatments for GERD are medical – proton pump inhibitors (PPIs) and laparoscopic antireflux surgery (LARS). Both treatments have advantages and side effects that continue to be debated. On one hand, medical therapy may be associated with residual regurgitation and the potential long-term side effects of PPI (eg, osteoporotic fractures, drug–drug interaction). On the other hand, LARS may be associated with technical failures, dysphagia and bloating.


Under the acronym LOTUS, this 5-year randomised study compared efficacy and safety of LARS with ‘optimised’ PPI/oral esomeprazole (ESO) therapy for the long-term management of GERD. LOTUS is an open, parallel group, multicentre, randomised, controlled trial undertaken in expert and …

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  • Competing interests None.