What is ARMA?

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:

  • Have ongoing reflux symptoms despite medication

  • Have no large hiatus hernia

  • 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:

  • Gastroscopy – to assess anatomy and check for hiatus hernia

  • 24-hour pH study – to measure acid exposure in your oesophagus

  • Oesophageal manometry – to assess muscle function in the oesophagus

These tests ensure ARMA is the right fit for your individual condition.

What to Expect

  • Procedure duration: 30–40 minutes

  • Hospital stay: Usually same-day discharge

  • Recovery: Gradual return to normal diet over one week

  • Medication: 8 weeks of high-dose proton pump inhibitors (PPIs) post-procedure

  • 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:

  • Bleeding (3%) – usually minor and managed during the procedure

  • Temporary pain – common in the first few days

  • Difficulty swallowing (13%) – may require gentle balloon dilation

  • Persistent reflux symptoms (up to 20%)

  • Rare complications: infection, fever, or perforation (very uncommon)