Efficacy and safety of anti reflux mucosal ablation (ARMA) for proton pump inhibitor (PPI) – refractory gastroesophageal reflux disease(GERD) – A single center prospective study

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Aims Evaluation of the clinical efficacy and safety of Anti-Reflux Mucosal Ablation (ARMA) therapy in patients with proton pump inhibitor (PPI)-refractory gastroesophageal reflux disease (GERD). Methods This single-center prospective study, conducted at SR Kalla Memorial Gastroenterology Hospital in Jaipur, India, included 45 patients with symptomatic GERD who were receiving daily oral PPI for at least 12 weeks. Esophagogastroduodenoscopy (EGD), pH studies, and high-resolution esophageal manometry (HREM) were performed on all screened patients. Quality of life was measured in these patients using the GERD Health-Related Quality of Life (GERD-HRQL) and the Frequency Scale for Symptoms of GERD (FSSG). ARMA was performed in a standardised fashion using Argon plasma coagulation (APC) ablation. Patients were followed up at 3 months after procedure with repeat EGD, HREM, GERD-HRQL, and FSSG assessment [ 1 ] [ 2 ] [ 3 ]. Results A total of 45 patients (57.8% males; median age, 52.5 years) underwent ARMA. Significant improvements in patient-reported outcomes were observed at 3 months post-procedure. The mean GERD-HRQL score decreased significantly from 38.2±6.8 to 12.4±7.2 (p<0.001). Similarly, FSSG scores dropped significantly from 22.3±5.4 to 10.2±6.1 (p<0.001).Physiologic testing demonstrated effective control of pathological acid exposure. The mean DeMeester score improved significantly from 35.8±28.6 to 8.4±6.2 (p<0.001).Mean AET also reduced significantly from 20.8% to 2.8% (p<0.001). Endoscopic assessment confirmed enhancement of the anti-reflux barrier.Anatomical improvement was further supported by 68.9% patients showing an improvement of≥1 Hill's Grade.Regarding mucosal status, the proportion of no esophagitis increased from 29 (64.4%) to 36 (80%). The prevalence of Grade A and Grade B decreased significantly post-procedure. The safety profile of ARMA was favourable, only minor and transient adverse events were recorded, no major complications such as perforation, stenosis, or bleeding occurred. At 3-month follow-up, 88.9% of patients had either reduced or discontinued PPI use, demonstrating reduced pharmacological dependence. Conclusions ARMA demonstrated significant efficacy and safety for PPI-refractory GERD. The procedure substantially improved subjective scores (GERD-HRQL, FSSG) and objective markers (DeMeester score, AET, Hill's grade). A high rate of PPI reduction/cessation affirms ARMA's role as a promising minimally invasive treatment for long-term GERD management. Publication History Article published online: 05 June 2026 © 2026. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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