Is the ARMA procedure for treating gastroesophageal reflux disease really safe

If you suffer from persistent acid reflux and heartburn, and medication-based treatments haven’t worked, the ARMA technique has emerged as an innovative, non-surgical solution to treat the problem safely and effectively.The procedure relies on using an endoscope to strengthen the lower esophageal sphincter (LES), preventing acid reflux and improving your quality of life without major surgery.

In this Delly Medical article, we will discuss:

• The benefits of the ARMA technique

• Procedure steps

• Recovery time

• Diet after the procedure

• Safety and potential complications

What is the ARMA Procedure for Treating Acid Reflux?

ARMA stands for Anti-Reflux Mucosal Ablation, a modern non-surgical technique for treating acid reflux. The main idea is that the doctor performs a controlled ablation (burning) of the mucosal layer at the lower end of the esophagus, where it connects to the stomach.

Why is this done?
When this area heals, scar tissue forms, slightly tightening the lower esophageal sphincter (LES) and reducing the opening that allows acid to flow back, thereby significantly reducing heartburn and reflux symptoms.

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ARMA Procedure Steps

1. Submucosal Injection (Optional)
   The doctor may inject fluid under the mucosa to lift the layer and minimize risks during ablation.

2. Targeted Ablation
   The mucosa is carefully ablated using an endoscope.

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Effectiveness and Safety of ARMA

Effectiveness:

• Studies show ARMA is highly effective for patients dependent on long-term acid-suppressing medications.

• Clinical success rates range from 72% to 87% within one year, which is very high compared to other non-surgical methods.

Safety:

• Temporary mild difficulty swallowing may occur.

• In rare cases, esophageal dilation may be needed if slight narrowing occurs.

• Serious complications are very rare.

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Who is a Candidate for ARMA?

ARMA is suitable for certain patients, especially when medications are insufficient:

• Mild to moderate reflux patients:

  • Frequent heartburn

  • Acid reflux sensation

  • Nausea or cramping due to reflux

  • Symptoms not stabilized with medication

• Patients for whom medications are ineffective:

  • High doses of PPIs are required, or symptoms return after stopping medication.

• Patients seeking a non-surgical solution:

  • Endoscopic procedure, no major surgery or general anesthesia required.

• Patients with small hiatal hernia:

  • Helps strengthen the sphincter and prevent acid reflux.

• Patients who want to reduce medication use:

  • Can reduce or stop daily acid-suppressing drugs after improvement.

• Patients without medical contraindications:

  • Normal esophagus (no severe fibrosis)

  • No active gastric ulcer

  • No conditions preventing endoscopy

• Patients willing to adopt lifestyle changes:

  • Healthy diet

  • Weight management

  • Avoid reflux-triggering foods

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Recovery Time After ARMA

• Full recovery: 1–2 weeks

• Most patients return to work and daily activities in 3–4 days

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Can Acid Return After ARMA?

• Rarely

• Most patients experience long-lasting improvement, especially if they maintain a healthy lifestyle

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Impact on Eating

• Mild difficulty swallowing may occur for a few days, but it gradually improves

• Normal eating resumes shortly with adherence to the doctor’s instructions

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Age Suitability

• Preferred for adults with chronic reflux

• May not be suitable for children or elderly patients with serious health issues

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Is ARMA a Substitute for Surgery?

• ARMA is an excellent non-surgical option to avoid or delay major surgery.

• Not suitable for all cases

When ARMA can replace surgery:

• Mild to moderate reflux

• Persistent heartburn despite medication

• Provides effective results without incisions or general anesthesia

When surgery is still preferred:

• Severe reflux

• Large hiatal hernia

• Significant esophageal wall damage

• Advanced Barrett’s esophagus

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Advantages of ARMA

1. Non-surgical procedure – Endoscopic only, no incisions or stitches, lower infection and bleeding risk

2. Rapid symptom improvement – Reduces heartburn, nausea, and belching within weeks

3. Strengthens LES – Scar tissue tightens the sphincter, reducing acid reflux

4. Reduces reliance on medication – Many patients can reduce or stop PPIs

5. Very fast recovery – Most go home the same day and return to normal life within days

6. Safe for most patients – Suitable for mild to moderate reflux, especially if surgery is not possible

7. Long-term results – Improvement can last months to years with simple follow-up

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Types of ARMA

1. Conventional ARMA – Basic endoscopic approach, suitable for most mild to moderate cases

2. Advanced Endoscopic ARMA – More precise instruments to control intensity and location, reduces tissue irritation, suitable for persistent symptoms

3. ARMA with Manometry Guidance – Uses esophageal pressure measurement during the procedure for personalized results

4. Partial ARMA – Targets only part of the LES, suitable for very mild cases or partial sphincter weakness

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Stages of ARMA Procedure

1. Pre-procedure preparation

   • Gastroenterologist consultation

   • Diagnostic tests: endoscopy, manometry, imaging if needed

   • Adjust medications, stop anticoagulants if necessary

   • Fasting for 6–8 hours

2. Anesthesia and readiness

   • Local anesthesia with mild sedation

   • Patient relaxed but conscious

3. Endoscope insertion

   • Thin endoscope inserted via the mouth to the LES

   • Equipped with precise tools for ARMA

4. Target area identification

   • Doctor marks areas of the sphincter to be strengthened

   • Manometry may be used for accuracy

5. ARMA application

   • Laser or mechanical energy used to strengthen the sphincter and reduce reflux

6. Procedure completion and follow-up

   • Duration: 30–60 minutes

   • Short observation post-procedure

   • Most patients go home the same day or next day

7. Recovery and follow-up

   • Improvement appears in a few weeks

   • Temporary mild difficulty swallowing, mild heartburn, or bloating may occur

   • Adherence to a healthy diet and avoiding triggers is essential for success

3️⃣ Endoscope Insertion

A thin endoscope is inserted through the mouth to reach the lower end of the esophagus.

The endoscope is equipped with precise tools to perform ARMA safely and accurately.

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4️⃣ Identifying Treatment Areas

The doctor determines the points along the lower esophageal sphincter (LES) that need strengthening.

In some cases, esophageal pressure measurement (manometry) is used during the procedure to ensure the most accurate treatment placement.

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5️⃣ ARMA Application

Mechanical energy or laser is applied to achieve a controlled therapeutic effect on the tissue.

Primary goal: Strengthen the LES, prevent acid reflux, and improve sphincter closure.

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6️⃣ Procedure Completion and Immediate Follow-up

• Procedure duration: 30–60 minutes

• Short post-procedure monitoring

• Most patients can return home the same day or within 24 hours

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7️⃣ Recovery and Follow-up After the Procedure

• Symptom improvement occurs gradually over a few weeks.

• Temporary symptoms may include:

  • Mild heartburn

  • Bloating

  • Mild difficulty swallowing

• These usually resolve over time.

• Long-term success depends on following a healthy diet and avoiding triggers.

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Side Effects of ARMA for Acid Reflux

ARMA is generally very safe, but like any medical procedure, some side effects may occur—mostly mild and temporary.

1️⃣ Common Temporary Effects

• Mild chest or esophageal discomfort

• Temporary dysphagia (difficulty swallowing) that improves gradually

• Bloating or gas after endoscopy

• Mild nausea for the first 1–2 days

2️⃣ Rare Effects

• Mild irritation or inflammation of the esophageal lining

• Minor bleeding during or after the procedure, usually controllable

• Incomplete symptom relief, especially in severe reflux or large hiatal hernia

• Very rare risk of esophageal perforation

3️⃣ How to Minimize Risks

• Follow the prescribed post-procedure diet

• Avoid spicy, fatty foods, carbonated drinks, and caffeine

• Regular follow-up with your doctor and necessary tests

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Recovery Timeline After ARMA

⏱ Day 1

• Most patients go home the same day or after one night

• Rest is recommended; avoid heavy exertion

⏱ First Week (Days 1–7)

• Mild heartburn, cramps, or gas may occur

• Follow a diet of fluids, then soft foods

⏱ Week 2–4

• Symptoms improve noticeably

• Patients can gradually resume daily activities

• Continue avoiding reflux-triggering foods

⏱ After ~1 Month

• Most patients experience significant relief from heartburn and acid reflux

• Gradual return to normal diet while monitoring for symptoms

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Important Post-ARMA Tips

Immediate Post-Procedure

• Rest for the first 1–2 days

• Gradually resume activity

• Avoid heavy lifting or strenuous effort for 3–5 days

Recommended Diet

First 2 days – Clear Fluids

• Water at moderate temperature

• Light tea

• Warm herbal drinks

• Clear, fat-free soup

• Light, unsweetened natural juices

Days 3–End of Week 1 – Full Fluids & Semi-Solid

• Mashed vegetable soups

• Yogurt

• Mashed potatoes

• Light jelly

• Light natural juices

Avoid:

• Fried foods

• Solid meats

• Heavy bread or pasta

Week 2 – Soft Diet

• Minced or boiled chicken

• Grilled fish

• Boiled eggs

• Cottage cheese

• Boiled vegetables

• Soft fruits like banana or grated apple

Tips:

• Eat small portions

• Chew slowly

• Avoid eating 2 hours before bedtime

After 2 Weeks – Gradual Return to Normal Diet

• Lean grilled meats

• Cooked vegetables

• Simple beans without oil

• Light salads

• Oatmeal

• Boiled rice in small quantities

Tips:

• Small, frequent meals

• Chew food well

• Drink water between meals, not with meals

Foods to Avoid

• Fatty and fried foods

• Heavy desserts and chocolate

• Carbonated drinks and caffeine (first 2 weeks)

• Eating too fast

• Drinking large amounts of water during meals

Water Intake

• 1.5–2 liters daily, small sips

• Avoid drinking large amounts at once

Lifestyle Tips for Best Results

• Use a small plate to control portion size

• Stop eating when full

• Daily walking 20–30 minutes

• Following the diet ensures lasting results

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Medications After ARMA

After ARMA, most patients need mild medications for a short period to reduce symptoms, protect the esophagus, and promote recovery.

1️⃣ Acid-Suppressing Medications (PPIs – Proton Pump Inhibitors)

Purpose: Reduce acid secretion and protect the esophageal lining during healing

Examples:

• Omeprazole

• Esomeprazole

• Pantoprazole

Duration: 1–4 weeks depending on the patient and doctor’s instructions

2️⃣ Mild Pain Relievers

Purpose: Relieve minor cramps or discomfort
Examples:

• Paracetamol

• Antispasmodics like Duspatalin or Gradient

⚠️ Important: Avoid anti-inflammatory painkillers such as Ibuprofen or Ketoprofen, which may irritate the stomach and increase acidity

3️⃣ Anti-Nausea Medications (If Needed)

Examples:

• Zofran

• Primperan

4️⃣ Vitamin Supplements (If Needed)

Not essential for all, but important if food intake is limited or nutrient deficiencies occur
Examples:

• Vitamin B12

• Iron supplements

• Calcium + Vitamin D

5️⃣ Stomach/ Muscle Relaxants (For Spasms)

Used if the patient experiences stomach tightness or strong cramps
Examples:

• Motilium

• Duspatalin

6️⃣ Electrolyte-Fluids

Not direct medication, but important to prevent dehydration, especially in the first week
Examples:

• Rehydration salts

• Light sugar-free drinks