What is ARMA?
Anti-Reflux Mucosal Ablation, or ARMA, is a minimally invasive endoscopic procedure designed to treat chronic gastroesophageal reflux disease (GERD).
It is a newer, less invasive alternative for selected patients who do not get adequate relief from acid-suppressing medicines such as proton pump inhibitors (PPIs), or who wish to reduce long-term dependence on medication and avoid traditional anti-reflux surgery where appropriate.
During the procedure, controlled superficial mucosal ablation is performed around the gastroesophageal junction (GEJ), where the esophagus meets the stomach. Argon plasma coagulation (APC) is commonly used for the ablation. As the treated area heals over the following weeks, scar contraction can tighten the junction and strengthen the natural anti-reflux barrier.
An Endoscopic Option When Medication Is Not Enough
ARMA is not suitable for every patient with reflux. Your doctor will consider your symptoms, response to treatment, endoscopy findings, hiatus hernia size, esophageal function, and—when appropriate—objective reflux testing before recommending the procedure.
Persistent Reflux Symptoms
May be considered when heartburn, regurgitation, or other reflux symptoms continue despite appropriate PPI therapy.
Reduce Long-Term Medication
Selected patients may consider ARMA when they wish to reduce or avoid long-term acid-suppressing medication.
Less Invasive Than Surgery
For carefully selected patients, ARMA may offer a less invasive endoscopic alternative to conventional anti-reflux surgery.
Small Hiatus Hernia
ARMA has been studied mainly in selected patients with no or small hiatus hernias, commonly around 2–3 cm or less.
GERD-Related Esophagitis
In selected patients with reflux-related esophageal inflammation or other GERD complications, ARMA may be considered as part of a broader treatment plan.
Careful Patient Selection
Large hiatus hernias, major esophageal motility disorders, or other complex conditions may require a different treatment approach.
How Can ARMA Help with a Small Hiatus Hernia?
A hiatus hernia occurs when part of the stomach moves upward through the diaphragm, which can weaken the anti-reflux barrier and worsen GERD. ARMA does not physically pull the stomach back down or repair the hernia. Instead, controlled ablation around the gastroesophageal junction creates healing and scar contraction that may tighten the junction and improve the anti-reflux barrier. This may reduce reflux symptoms in carefully selected patients with a small hiatus hernia.
What Happens During ARMA?
ARMA is a specialised therapeutic endoscopic procedure. A controlled pattern of mucosal ablation is created around the gastroesophageal junction to improve its anti-reflux function during the healing process.
Sedation & Endoscopy
Intravenous sedation is used according to the patient’s condition, and the gastroesophageal junction is examined through an endoscope.
Define the Treatment Area
The doctor identifies the specific mucosal area around the gastric cardia where ablation will be performed.
Controlled Mucosal Ablation
Using a technique such as argon plasma coagulation, controlled thermal energy is applied in a planned pattern, often crescent-shaped or horseshoe-shaped.
Healing & Tightening
Over the following weeks, healing and scar formation can contract the treated area and strengthen the anti-reflux barrier.
Designed to Be Comfortable Under Sedation
ARMA is usually performed under intravenous sedation, so most patients are deeply relaxed and experience little or no awareness of the procedure. Published series often report procedure times around 30–40 minutes, although the actual duration varies according to the patient and technique used.
What Should You Expect After ARMA?
You will be monitored in recovery until the effects of sedation have worn off. Most uncomplicated cases can be managed without a prolonged hospital stay.
Liquid or Soft Diet
A temporary liquid or soft diet may be recommended for several days. Follow the specific dietary instructions provided by your clinical team.
Temporary Discomfort
Mild chest discomfort, a sore throat, or temporary discomfort with swallowing may occur and usually improves as healing progresses.
Effect Develops Gradually
The anti-reflux effect is not immediate. Improvement develops over several weeks, and the response is often assessed around 1–2 months after treatment.
What Should You Watch for After ARMA?
Tell your doctor about all medical conditions and medicines you take. If you use blood thinners or antiplatelet medicines, your doctor will advise how they should be managed before and after the procedure. Seek prompt medical attention if you develop severe or worsening chest pain, fever, significant difficulty swallowing, vomiting blood, breathing difficulty, or unusual weakness.
ARMA is a Promising Endoscopic Option for Selected GERD Patients
ARMA has shown encouraging results in selected patients with GERD that remains troublesome despite medication, particularly when there is no large hiatus hernia. Studies report meaningful symptom improvement in many patients, and some are able to reduce or discontinue PPI therapy after treatment. However, ARMA is still a relatively new technique and long-term evidence continues to develop. Careful patient selection, specialist assessment, and follow-up remain essential.