At a glance: ARMA is an endoscopic treatment option for carefully selected patients with persistent reflux despite appropriate medical assessment.
Anti-Reflux Mucosal Ablation (ARMA) is a cutting-edge endoscopic procedure designed to treat Gastro-Oesophageal Reflux Disease (GORD) in patients who continue to experience symptoms despite acid-lowering medications.
Originally developed in Japan in 2014, ARMA offers a safe, non-surgical alternative to traditional fundoplication, helping to restore the natural barrier at the gastro-oesophageal junction and reduce reflux.
Who Might Benefit from ARMA?
ARMA may be appropriate for patients who:
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Have ongoing reflux symptoms despite medication
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Have no large hiatus hernia
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Prefer a less invasive option than surgery
How Does ARMA Work?
During a gastroscopy, a shallow ring-shaped burn is created at the top of the stomach using argon plasma coagulation. As this area heals, scar tissue forms, narrowing the junction and re-establishing a natural anti-reflux barrier (Hill Grade 1 flap valve).
The result? Fewer reflux episodes, reduced symptoms, and in many cases, less reliance on daily medication.
Pre-Procedure Investigations
Before undergoing ARMA, you may need:
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Gastroscopy – to assess anatomy and check for hiatus hernia
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24-hour pH study – to measure acid exposure in your oesophagus
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Oesophageal manometry – to assess muscle function in the oesophagus
These tests ensure ARMA is the right fit for your individual condition.
What to Expect
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Procedure duration: 30–40 minutes
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Hospital stay: Usually same-day discharge
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Recovery: Gradual return to normal diet over one week
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Medication: 8 weeks of high-dose proton pump inhibitors (PPIs) post-procedure
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Follow-up: Symptom review at 3 and 6 months, with repeat pH testing and gastroscopy
Recovery Diet Plan
| Days | Diet Type | Description |
|---|---|---|
| Day 1 | Liquid Only | Water, juice, protein-rich drinks (e.g. Ensure, Up & Go) |
| Days 2–3 | Puree Diet | Blended vegetables, fruit, porridge, mashed tofu |
| Days 4–6 | Soft Diet | Mashed vegetables, soft meats, stewed fruit, scrambled eggs |
Small, frequent meals and sitting upright while eating are recommended.
Potential Risks
ARMA is generally very safe, but like all procedures, it carries some risks:
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Bleeding (3%) – usually minor and managed during the procedure
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Temporary pain – common in the first few days
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Difficulty swallowing (13%) – may require gentle balloon dilation
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Persistent reflux symptoms (up to 20%)
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Rare complications: infection, fever, or perforation (very uncommon)
Frequently asked questions
Who may be suitable for ARMA?
It may be considered after objective assessment in selected patients with persistent reflux who are not adequately controlled with standard management.
Does ARMA replace all reflux medicines?
Not necessarily. Medicine requirements are reviewed after healing and depend on symptoms and test results.
Will I need follow-up gastroscopy?
Follow-up varies according to the treatment plan, symptoms and whether additional therapy is required.
After your procedure
Follow the written discharge instructions supplied for your procedure. Contact the clinic or seek urgent care for severe or increasing pain, heavy bleeding, fever, persistent vomiting, breathing difficulty, fainting or other concerning symptoms.
Book or refer
For appointments or referral information, visit our endoscopy referral and booking page.