NEW YORK (Reuters Health) – Among patients with gastroesophageal reflux disease (GERD), treatment success rates at 5 years are similar with proton pump inhibition using esomeprazole or with laparoscopic antireflux surgery, according to a report in the May 18th issue of the Journal of the American Medical Association.

Given the chronic nature of GERD, a long-term treatment plan is needed, Dr. Jean-Paul Galmiche, at Nantes University, France, and an international team point out in their report. One option is maintenance therapy with a proton pump inhibitor, another is antireflux surgery for patients who may not want to take long-term medication.

The group examined outcomes of the two approaches in 554 patients with chronic GERD who initially responded well to acid suppression and were subsequently assigned to receive esomeprazole 20 to 40 mg/d allowing for dose adjustments, or to undergo laparoscopic antireflux surgery (LARS).

Of the original group, 372 patients completed 5 years of follow-up, according to the report. Treatment failure was defined as the need for acid suppressive therapy in LARS patients and as inadequate symptom control in the patients given esomeprazole.

Estimated remission rates at 5 years were not significantly different between the two arms after adjustment for the drop-out effect, at 92% with esomeprazole and 85% with LARS, the investigators found.

The prevalence of heartburn symptoms was similar in the two groups at 16% and 8%, respectively (p=0.14), whereas rates of acid regurgitation were high with esomeprazole than LARS at 13% vs 2% (p<0.001), the report indicates.

On the other hand, the prevalence of dysphagia was significantly lower with esomeprazole (5%) than LARS (11%), as was bloating (28% vs 40%) and flatulence (40% vs 57%).

Cumulative 5-year rates of serious adverse events were 24.1% in the esomeprazole arm compared with 28.6% in the LARS arm, Dr. Galmiche and colleagues report.

“In summary,” they conclude “most patients with GERD who are initially responsive to PPIs achieve and remain in remission at 5 years with contemporary antireflux therapy using either LARS or esomeprazole in a dose-escalating manner when required.”

JAMA 2011;305:1969-1977.