Laparoscopic fundoplication is the treatment of choice for gastro-oesophageal reflux disease
Bibliographic record
Abstract
Although the technical principles of surgical repair remain the same in laparoscopic practice as in the classical open procedure, the increasing enthusiasm of patients and many physicians for this so-called “mini invasive” surgery has led to its greater use and wider indications for surgery in gastro-oesophageal reflux disease (GORD). The notion behind this proposed change in current practice is that antireflux surgery (ARS) is more “cost effective” than medical therapy and possibly safer with regard to the long term effects of acid suppression and occurrence of adenocarcinoma of the oesophagus in patients with severe chronic GORD. Our position challenges this view, which in our opinion is not supported by scientific evidence and data in the recent literature. If it is assumed that modern drug therapy and ARS are both effective in the treatment of GORD, a comparison between them should concentrate on several end points that have been recognised as major goals of antireflux therapy. Hence in addition to healing of oesophagitis, emphasis now needs to be given to complete symptom relief, return to a normal quality of life, and long term control of the disease (that is, prevention of recurrences and complications). Tolerance, safety, and costs are also important issues. Comparison is limited by lack of randomised trials between laparoscopic surgery and modern drug therapy (that is, proton pump inhibitors (PPIs)). Although Spechler1 first reported that open ARS was significantly better than medical therapy after two or three years of follow up, the comparison involved drugs which are no longer considered as optimal therapy for GORD. Interestingly, the same author recently reassessed the long term outcome of these cohorts of medically and surgically treated patients after a median follow up of approximately 10 years.2 Oesophagitis grade, quality of life scores, satisfaction with antireflux therapy, and frequency of …
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.008 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".