Anti-reflux mucosal ablation (ARMA) - a new treatment for gastroesophageal reflux refractory to proton pump inhibitors?

Abstract

Anti-reflux mucosal ablation (ARMA) - a new treatment for gastroesophageal reflux refractory to proton pump inhibitors? Marta Miguel Caetano2, Armando Peixoto1,2, Isabel Garrido1,2, Ana Luísa-Santos1,2, Rui Morais1,2, Guilherme Macedo1,2 1 - Gastrenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal 2- Faculdade de Medicina da Universidade do Porto Abstract Background and aims: Gastroesophageal reflux disease (GERD) is one of the most common digestive diseases. Anti-reflux mucosal ablation (ARMA) is a promising endoscopic procedure for gastroesophageal reflux refractory to proton pump inhibitors (PPI-rGERD). Our study aims at evaluating the feasibility, safety and impact on the quality of life of patients with PPI-rGERD submitted to ARMA. Methods: Prospective single-center study of patients with PPI-rGERD who were submitted to ARMA between January 2021 and December 2023. GERD Health- Related Quality of Life Questionnaire (GERD-HRQL) evaluation, Frequency Scale for the Symptoms of GERD (FSSG), Esophageal Hypervigilance and Anxiety Scale (EHAS) score assessment, esophagogastroduodenoscopy (EGD) and 24- hour pH/impedance reflux testing were performed at baseline and 3 months post- ARMA. Results: Eighteen patients were included, the majority male (55.6%), with a median age of 51 years (range 26-73). There was a significant improvement in the median GERD-HRQL score, FSSG score and EHAS score. Follow-up EGD showed no statistically significant improvements in the Los Angeles Classification of Esophagitis (p=0.146) or Hill's flap valve grade (p=0.083). The median acid exposure time (AET) significantly decreased after ARMA from 10.5% to 4.4 (p=0.037). Six (33.3%) patients suspended PPI and remain asymptomatic in the follow-up, while 3 patients underwent surgery. Conclusion: ARMA is a promising technique for PPI-rGERD, providing safety and symptomatic improvement. However, larger studies with long-term follow-up evaluations are required to confirm the efficacy of this procedure in the long run.