Anti-Reflux Mucosal Ablation (ARMA)

Anti-Reflux Mucosal Ablation (ARMA) is an endoscopic procedure used to treat Gastro-Oesophageal Reflux Disease (GORD) in patients who continue to have symptoms despite acid-lowering medications.
The procedure is performed using a narrow, flexible tube called a gastroscope, which has a camera at the tip to capture images of your oesophagus and stomach.

Why is an ARMA performed?

• To treat gastro-oesophageal reflux by improving the function of the lower oesophageal sphincter (the valve between the oesophagus and the stomach).
• To reduce the frequency and severity of reflux episodes, improve symptoms, and in many cases, reduce reliance on daily medication.

What is the preparation for an ARMA?

The safest way to perform the procedure is on an empty stomach.

You should have nothing to eat six hours prior to your ARMA, but you may drink clear fluids up until two hours before your procedure.

It is very important you tell your specialist at least five days before your procedure about any medications you take. If you are on essential medications, you may be able to take them with small sips of water. You may need to adjust your usual dose or stop certain medications, such as iron tablets. If you are taking blood thinning medications (warfarin, dabigatran, clopidogrel, ticagrelor, dipyridamole, rivaroxaban or others) or weight loss medication such as Wegovy please call the MacMurray Centre for advice.

Before undergoing an ARMA you may need:

• Gastroscopy – to assess anatomy and check for hiatus hernia.
• 24 hour pH study – to measure acid exposure in your oesophagus.
• Oesophageal Manometry – to assess muscle function in the oesophagus.

How is an ARMA performed?

During a gastroscopy, a shallow ring-shaped burn is made at the top of the stomach using argon plasma coagulation.

As this area heals, scar tissue forms, narrowing the junction between the oesophagus and stomach, re-establishing a natural anti-reflux barrier. This results in fewer reflux episodes, reduced symptoms, an in many cases, less reliance on daily medications.

The procedure generally takes 30-40 minutes and is completed under full general anaesthetic.

What happens after an ARMA?

After your procedure, it is common to have some chest or abdominal discomfort, for which you will be given pain relief. You will be monitored in recovery for at least 3 hours and discharged the same day.

On discharge, you will be given a prescription for:

• Omeprazole – to reduce acid, allow healing and prevent reflux.
• Pain relief – to manage discomfort.

You can usually resume normal activities the day after your procedure.

Recovery Diet Plan

To reduce discomfort and allow your oesophagus to heal, it is recommended you follow the recovery diet plan. Please refer to appendix 1 for liquid and soft diet examples:

• Day 1-3: Liquid diet.
• Day 4-6: Soft diet.
• Day 7: Resume normal diet as tolerated.

Additional tips

• Eat and drink slowly, and chew food thoroughly.
• Have small, frequent meals to avoid putting pressure on your stomach.
• Sit upright while eating or drinking, and avoid lying flat after meals.

Oral care

It is important to maintain good oral hygiene while you recover:

• Brush your teeth regularly.
• Drink water after any sugar-sweetened drink.

Follow-up

Things can take some time to settle and improve. You will have a review with your specialist 3 months post procedure to assess your symptoms.

ARMA is generally a safe and minimally invasive procedure. Complications are rare but may include:

• Bleeding: Rarely, late bleeding can occur within two weeks and may require hospital admission and treatment, including blood transfusion.
• Perforation: A hole is made in the oesophagus or stomach wall (<1% of cases) which may require a prolonged hospital stay or surgery.
• Pain: Around 25% of patients may have pain lasting more than 48 hours, pain relief will be provided.
• Dysphagia: Difficulty swallowing occurs in about 13% of patients and may require oesophageal dilatation.
• Clinical success: Seen in around 80% of patients, with 70% stopping PPIs completely and a further 10% reducing their dose.

If you have a fever, vomit more than half cup of fresh red blood or have persistent black stools please notify your specialist.

If you have any queries or concerns please do not hesitate to contact the MacMurray Centre:

Auckland (09) 550 1080

Cambridge (07) 444 4600

Tauranga (07) 777 0600

Christchurch (03) 662 9290

This is a guide only. Some patients may need longer at each step.

Day 1-3: Any liquids

Milky drinks

These are a good source of energy and protein. Powdered options include:

• Milo, Horlicks, Bournvita, Ovaltine, Nesquik, drinking chocolate – made with milk
• Complan, Vitaplan, Sustagen, Ensure, Fortisip.
• Ready to drink options:
• Standard full fat (dark blue top) or high protein (yellow or orange top) milk, soy milk or flavoured milk.
• Drinking yoghurts, fruit smoothies, Up & Go, Calci-trim Liquid Breakfast, Primo Extremo.

Juice based drinks

These are a good source of energy and a suitable alternative for those who do not like milky drinks.

• Fruit juices or drinks eg. Just Juice, Ribena, cordial, Raro/ Vitafresh
• Sports drinks eg. Mizone, Powerade.

What if I am “lactose free” or “dairy free”?

It is still important to consider nutritious drinks as a supplement to your diet. If you are lactose free consider using lactose free milk in place of standard milk. If you are dairy free it is best to choose soy milk or goats’ milk as these contain more protein and energy than other milks such as almond, rice or oat.

Days 4-6: Soft diet

Pureed meals can be made by cooking foods until soft and tender, and then blending them through a kitchen  blender. Adding sauces and gravies helps to moisten foods and makes it easier to swallow.