Anti reflux mucosal ablation is safe and effective in reducing the symptoms of gastroesophageal reflux disease in patients resistance to proton pump inhibitors: A controlled clinical trial

Aims To evaluate the efficacy and safety of anti reflux mucosal ablation (ARMA) in comparison to proton pump inhibitors (PPIs) in patients with persistent GERD symptoms.

Methods In this non-randomized controlled interventional trial, between October 2023 to February 2024, patients with persistent GERD symptoms were allocated to either ARMA or PPI. GERD-Health Related Quality of Life (GERD-HRQL) Questionnaire, Frequency Scale for the Symptoms of GERD (FSSG), upper endoscopy, PPI use and adverse events were evaluated at baseline and three months post-ARMA.

Results A total of 48 patients (31 females [64.6%]; mean age 39.47±14.88) completed our study of 24 patients underwent ARMA (17 females [70.8%]; mean age 41.35±14.43) and 24 were taking esomeprazole 20 mg twice daily. After three months, ARMA significantly alleviated both mean GERD-HRQL (29.08±7.95 versus 7.42±3.85, P<0.001) and FSSG (24.71±5.17 versus 7.46±3.63, p<0.001). Furthermore, three-month GERD-HRQL and FSSG were significantly lower in the ARMA group in comparison to the PPI group. (7.42±3.85 versus 23.83±7.29, p<0.001 and 7.46±3.63 versus 20.75±5.33, p<0.001, respectively. Notably, 79.2% of patients in the ARMA were able to discontinue PPIs in comparison to 8.3% of patients in the control group (p<0.001). Multivariate analysis revealed that undergoing ARMA was the only predictor of GERD-HRQL and FSSG scores. Only one patient experienced heartburn after ARMA but no major adverse complications were observed [1] [2] [3] [4].

Conclusions Our study demonstrated that ARMA was feasible, tolerable and safe. Also, in short-term, it can alleviate the symptoms of GERD in patients with persistent symptoms more efficiently in comparison to esomeprazole. However, longer follow-ups and randomized studies are required to determine the exact efficacy of ARMA.

Publication History

Article published online:
27 March 2025

• References

• 1 Inoue H, Tanabe M, de Santiago ER. et al. Anti-reflux mucosal ablation (ARMA) as a new treatment for gastroesophageal reflux refractory to proton pump inhibitors: a pilot study. Endoscopy International Open 2020; 8 (2): E133-E138
• 2 Anti Reflux Mucosal Ablation Therapy in PPI Dependent GERD: a Prospective Randomized, Single-blinded, Sham-controlled Trial. 2023 https://clinicaltrials.gov/study/NCT05763485
• 3 Efficacy and Safety of Endoscopic Anti-reflux Mucosal Ablation Therapy for Gastroesophageal Reflux Disease: a Single Blind Randomized Sham Controlled Trial. 2023 https://clinicaltrials.gov/study/NCT06106100
• 4 Anti-Reflux Endoscopic Therapy Using Argon Plasma Coagulation (AREA) in Gastroesophageal Reflux Disease (GERD) Patients: A Single Center, Randomized, Sham, Controlled Trial (The AREA Study). 2022 https://clinicaltrials.gov/study/NCT05570448