Hailing as a novel treatment for people with reflux disease who have not responded to PPIs, Anti-reflux mucosectomy (ARMS) stands as an endoscopic procedure.

ARMS rebuilds the mucosal flap valve at gastric cardia (the area where the contents of the oesophagus empties into the stomach).

The ARMS procedure is based on the principle that after mucosal resection, the mucosal healing results in scar formation. This in turn results in shrinkage of the gastric cardia flap valve, leading to a reduction in reflux episodes by suppressing gastric backflow.

In early studies, researchers found that patients with PPI-refractory gastroesophageal reflux disease (GERD/ GORD) without a sliding hiatal hernia seem to be the best candidates for ARMS treatment.

How effective is it?

A 2019 study concluded that ARMS appears to be a safe procedure that does not hinder future laparoscopic anti-reflux surgery in case of failure.

It found the ARMS procedure to be technically successful in 19 patients with only one minor complication. Two thirds of patients showed symptomatic improvement and were able to discontinue their PPI medication. While three of the six failures went on to have additional anti-reflux surgery.

Among patients who did not have additional surgery, quality of life data showed significant symptomatic improvement by six months.

In 2021, researchers at the Digestive Diseases Center of Showa University Koto-Toyosu Hospital in Japan retrospectively evaluated the outcomes of ARMS performed in 109 patients with PPI-refractory GERD at the institution.

They also concluded ARMS is an effective minimally invasive therapy for patients with PPI-refractory GERD.

There was a significant improvement in symptoms and between 40 and 50 per cent of patients were able to discontinue PPI after the procedure. During the three-year follow-up, researchers observed a sustained improvement in subjective symptoms in the patients.

Long-term effects

In 2023,a study looked at 88 patients with GERD who had not responded to proton pump inhibitor medications. They underwent ARMS between June 2012 and June 2017.

The results showed that ARMS had a long-term effect in 68.3 per cent of the patients, and 42 per cent of them were able to stop taking PPI medications. The study also found significant differences in age, symptom intensity, and acid-related indicators among the patients. Additionally, ARMS was particularly effective in patients with reflux hypersensitivity, providing long-term relief for 81 per cent of them.

The study concluded that ARMS demonstrates long-term efficacy and can be a valuable treatment option for patients with GERD, including those with reflux hypersensitivity. This minimally invasive procedure offers a bridge between surgical and medical interventions, providing an alternative for individuals who have not responded well to conventional treatments.


ARMS is considered a safe and feasible endoscopic treatment for PPI-refractory GERD which doesn’t need expensive novel equipment because the procedure can be performed using endoscopic techniques that are already familiar to most endoscopists.

An early and objective diagnosis of reflux, such as Peptest provides, opens the door to lifestyle changes, and future treatment. Peptest can also be used after reflux treatments to assess the success or failure of any treatment. Find out more about Peptest and order your Peptest home testing kit now.

Article updated July 2023

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