G. Fedeli

Gastric mucosal lesions in celiac patients

the above letter, I find very little factual discrepancy between our viewpoints. The major points of my editorial were: 1) Antireflux surgery is more successful in the hands of experienced operators; 2) Complications of reflux disease are rare and unpreventable by any intervention; 3) Complications and adverse events occur with antireflux surgery; 4) Laparoscopic antireflux surgery is no more efficacious than the open procedure; 5) The strongest data for surgery pertain to patients with ulcerative esophagitis; 6) The economic arguments favoring antireflux surgery are severely flawed; and 7) Antireflux surgery can be tremendously beneficial to carefully selected patients. I hope that these are the messages that the readership extracts from the editorial. Regarding controlled data directly comparing laparoscopic antireflux surgery to modern medical therapy, I maintain that no relevant studies have been reported, and on that basis, I advise caution. Regarding the multitude of uncontrolled trials and observations demonstrating the efficacy of antireflux surgery, I only quote Sackett from his work on evidence-based medicine, “Therapeutic reports with controls tend to have no enthusiasm, and reports with enthusiasm tend to have no controls” (1).