Proton pump inhibitors (PPIs) are used to manage gastro-oesophageal reflux disease symptoms, but many people do not respond well to the medication.

The next option is anti-reflux surgery with a variety of endoscopic therapies now available, including STRETTA, MUSE and laparoscopic fundoplication.

Anti-reflux mucosectomy (ARMS) is an endoscopic procedure that has been hailed as a novel treatment for people with reflux disease who have not responded to PPIs.

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.

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

However, researchers warn that larger studies with long-term follow up are needed to assess the true success of ARMS.