***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background : With the introduction of laparoscopic antireflux surgery ( LARS ) for gastro-oesophageal reflux disease ( GORD ) along with the increasing efficacy of modern medical treatment , a direct comparison is warranted . The 3-year interim results of a r and omised study comparing both the efficacy and safety of LARS and esomeprazole ( ESO ) are reported . Methods : LOTUS is an open , parallel-group multicentre , r and omised and controlled trial conducted in dedicated centres in 11 European countries .  LARS was completed according to a st and ardised protocol , comprising a total fundoplication and a crural repair . Medical treatment comprised ESO 20 mg once daily , which could be increased stepwise to 40 mg once daily and then 20 mg twice daily in the case of incomplete GORD control . The primary outcome variable was time to treatment failure ( Kaplan – Meier analysis ) . Treatment failure was defined on the basis of symptomatic relapse requiring treatment beyond that stated in the protocol . Results : 554 patients were r and omised , of whom 288 were allocated to LARS and 266 to ESO .  The two study arms were well matched . The proportions of patients who remained in remission after 3 years were similar for the two therapies : 90 % of surgical patients compared with 93 % medically treated for the intention to treat population , p = 0.25 ( 90 % vs 95 % per protocol ) . No major unexpected postoperative complications were experienced and ESO was well tolerated . However , postfundoplication complaints remain a problem after LARS . Conclusions : Over the first 3 years of this long-term study , both laparoscopic total fundoplication and continuous ESO treatment were similarly effective and well-tolerated therapeutic strategies for providing effective control of GORD Background The fundoplication of choice for the surgical treatment of gastroesophageal reflux disease ( GERD ) still is debated . Multichannel intraluminal impedance monitoring ( MII ) has not been used to compare objective data , and comparative subjective data on laparoscopic Nissen and Toupet fundoplications are scarce . Methods This study r and omly allocated 125 patients with documented chronic GERD to either laparoscopic floppy Nissen fundoplication ( LNF ; n = 62 ) or laparoscopic Toupet fundoplication ( LTF ; n = 63 ) . The Gastrointestinal Quality of Life Index ( GIQLI ) , symptom grading , esophageal manometry , and MII data were documented preoperatively and 1 year after surgery . The pre- and postprocedure data were compared . Statistical significance was set at a p value lower than 0.01 ( NCT01321294 ) . Results Both procedures result ed in significantly improved GIQLI and GERD symptoms . Preoperative dysphagia improved in both groups , but the improvement reached significance only in the LTF group . The ability to belch was shown to be significantly more decreased after LNF than after LTF . Gas-bloat and “ atypical ” extraesophageal symptoms also were decreased after surgery ( p < 0.01 ) . However , bowel symptoms were virtually unchanged in both groups . Both procedures result ed in significantly improved lower esophageal sphincter pressures . The improvement was greater in the LNF group than in the LTF group ( p < 0.01 ) . The DeMeester score and the numbers of total , acid , proximal , upright , and recumbent reflux episodes decreased in both groups after surgery ( p < 0.01 ) . No significant difference between the procedures in terms of MII data was found . Six patients ( 4.8 % ) had to undergo reoperation because of intrathoracic slipping of the wrap . All the patients had undergone LNF . Conclusions Both procedures proved to be equally effective in improving quality of life and GERD symptoms . However , the reoperation and dysphagia rates were lower and the ability to belch was higher after LTF than after LNF BACKGROUND & AIMS It is important to evaluate the long-term effects of therapies for gastroesophageal reflux disease ( GERD ) . In a 12-year study , we compared the effects of therapy with omeprazole with those of antireflux surgery . METHODS This open , parallel group study included 310 patients with esophagitis enrolled from outpatient clinics in Nordic countries . Of the 155 patients r and omly assigned to each arm of the study , 154 received omeprazole ( 1 withdrew before therapy began ) , and 144 received surgery ( 11 withdrew before surgery ) . In patients who remained in remission after treatment , post-fundoplication complaints , other symptoms , and safety variables were assessed . RESULTS Of the patients enrolled in the study , 71 who were given omeprazole ( 46 % ) and 53 treated with surgery ( 37 % ) were followed for a 12-year follow-up period . At this time point , 53 % of patients who underwent surgery remained in continuous remission , compared with 45 % of patients given omeprazole with a dose adjustment ( P = .022 ) and 40 % without dose adjustment ( P = .002 ) . In addition , 38 % of surgical patients required a change in therapeutic strategy ( eg , to medical therapy or another operation ) , compared with 15 % of those on omeprazole .  Heartburn and regurgitation were significantly more common in patients given omeprazole , whereas dysphagia , rectal flatulence , and the inability to belch or vomit were significantly more common in surgical patients . The therapies were otherwise well-tolerated . CONCLUSIONS As long-term therapeutic strategies for chronic GERD , surgery and omeprazole are effective and well-tolerated . Antireflux surgery is superior to omeprazole in controlling overall disease manifestations , but post-fundoplication complaints continue after surgery Objective To examine the association between chronic use of proton pump inhibitors ( PPIs ) and risk of hip fracture .  Design Prospect i ve cohort study . Setting Nurses ’ Health Study , which originally recruited from the 11 most populous states in the US . Participants 79 899 postmenopausal women enrolled in the Nurses ’ Health Study who provided data on the use of PPIs and other risk factors biennially since 2000 and were followed up to 1 June 2008 . Main outcome measure Incident hip fracture Results During 565 786 person years of follow-up , we documented 893 incident hip fractures . The absolute risk of hip fracture among regular users of PPIs was 2.02 events per 1000 person years , compared with 1.51 events per 1000 person years among non-users . Compared with non-users , the risk of hip fracture among women who regularly used PPIs for at least two years was 35 % higher ( age adjusted hazard ratio 1.35 ( 95 % confidence interval 1.13 to 1.62 ) ) , with longer use associated with increasing risk ( Ptrend<0.01 ) . Adjustment for risk factors , including body mass index , physical activity , and intake of calcium did not material ly alter this association ( hazard ratio 1.36 ( 1.13 to 1.63 ) ) . These associations were also not changed after accounting for reasons for PPI use . The relation between PPI use and fracture differed by smoking history ( Pinteraction=0.03 ) . Among current and former smokers , PPI use was associated with greater than 50 % increase in risk of fracture , with a multivariate hazard ratio for fracture of 1.51 ( 1.20 to 1.91 ) . In contrast , among women who never smoked there was no association ( multivariate hazard ratio 1.06 ( 0.77 to 1.46 ) ) . In a meta- analysis of these results with 10 prior studies , the pooled odds ratio of hip fracture associated with PPI use was 1.30 ( 1.25 to 1.36 ) . Conclusion Chronic use of PPIs is associated with increased risk of hip fracture  , particularly among women with a history of smoking Objectives To determine the long term clinical effectiveness of  laparoscopic fundoplication  as an alternative to drug treatment for  chronic gastro-oesophageal reflux disease ( GORD ) .  Design Five year follow-up of multicentre , pragmatic r and omised trial ( with parallel non-r and omised preference groups ) . Setting Initial recruitment in 21 UK hospitals . Participants Responders to annual question naires among 810 original participants . At entry , all had had GORD for > 12 months . Intervention The surgeon chose the type of fundoplication . Medical therapy was review ed and optimised by a specialist . Subsequent management was at the discretion of the clinician responsible for care , usually in primary care . Main outcome measures Primary outcome measure was self reported quality of life score on disease-specific REFLUX question naire . Other measures were health status ( with SF-36 and EuroQol EQ-5D question naires ) , use of antireflux medication , and complications . Results By five years , 63 % ( 112/178 ) of patients r and omised to surgery and 13 % ( 24/179 ) of those r and omised to medical management had received a fundoplication ( plus 85 % ( 222/261 ) and 3 % ( 6/192 ) of those who expressed a preference for surgery and for medical management ) . Among responders at 5 years , 44 % ( 56/127 ) of those r and omised to surgery were taking antireflux medication versus 82 % ( 98/119 ) of those r and omised to medical management . Differences in the REFLUX score significantly favoured the r and omised surgery group ( mean difference 8.5 ( 95 % CI 3.9 to 13.1 ) , P<0.001 , at five years ) . SF-36 and EQ-5D scores also favoured surgery , but were not statistically significant at five years . After fundoplication , 3 % ( 12/364 ) had surgical treatment for a complication and 4 % ( 16 ) had subsequent reflux-related operations — most often revision of the wrap . Long term rates of dysphagia , flatulence , and inability to vomit were similar in the two r and omised groups . Conclusions After five years , laparoscopic fundoplication continued to provide better relief of GORD symptoms than medical management . Adverse effects of surgery were uncommon and generally observed soon after surgery . A small proportion had re-operations . There was no evidence of long term adverse symptoms caused by surgery . Trial registration Current Controlled Trials IS RCT N15517081 Objective To determine the relative benefits and risks of laparoscopic fundoplication surgery as an alternative to long term drug treatment for  chronic gastro-oesophageal reflux disease ( GORD ) . Design Multicentre , pragmatic r and omised trial ( with parallel preference groups ) . Setting 21 hospitals in the United Kingdom . Participants 357 r and omised participants ( 178 surgical , 179 medical ) and 453 preference participants ( 261 , 192 ) ; mean age 46 ; 66 % men . All participants had documented evidence of GORD and symptoms for > 12 months . Intervention The type of laparoscopic fundoplication used was left to the discretion of the surgeon . Those allocated to medical treatment had their treatment review ed and adjusted as necessary by a local gastroenterologist , and subsequent clinical management was at the discretion of the clinician responsible for care . Main outcome measures The disease specific REFLUX quality of life score ( primary outcome ) , SF-36 , EQ-5D , and medication use , measured at time points equivalent to three and 12 months after surgery , and surgical complications . Main results R and omised participants had received drugs for GORD for median of 32 months before trial entry . Baseline REFLUX scores were 63.6 ( SD 24.1 ) and 66.8 ( SD 24.5 ) in the surgical and medical r and omised groups , respectively . Of those r and omised to surgery , 111 ( 62 % ) actually had total or partial fundoplication . Surgical complications were uncommon with a conversion rate of 0.6 % and no mortality . By 12 months , 38 % ( 59/154 ) r and omised to surgery ( 14 % ( 14/104 ) among those who had fundoplication ) were taking reflux medication versus 90 % ( 147/164 ) r and omised medical management . The REFLUX score favoured the r and omised surgical group ( 14.0 , 95 % confidence interval 9.6 to 18.4 ; P<0.001 ) . Differences of a third to half of 1 SD in other health status measures also favoured the r and omised surgical group . Baseline scores in the preference for surgery group were the worst ; by 12 months these were better than in the preference for medical treatment group . Conclusion At least up to 12 months after surgery , laparoscopic fundoplication significantly increased measures of health status in patients with GORD . Trial registration IS RCT N15517081 Background A r and omized controlled trial ( RCT ) investigated patients with gastroesophageal reflux disease ( GERD ) who were stable and symptomatically controlled with long-term medical therapy to compare ongoing optimized medical therapy with laparoscopic Nissen fundoplication ( LNF ) . Methods Of the 180 patients eligible for r and omization , 104 gave informed consent , and 3 withd 
    Output:
    
Heartburn and regurgitation were less frequent after surgical intervention .
However , a considerable proportion of patients still needed antireflux medication after fundoplication .
Nevertheless , the surgical patients were significantly more satisfied with their symptom control and showed higher satisfaction with the treatment received .
Conclusions This systematic review showed that surgical management of GERD is more effective than medical management with respect to patient-relevant outcomes in the short and medium term .
However , long-term studies still are needed to determine whether antireflux surgery is an equivalent alternative to lifelong medical treatment