The efficacy of antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) for gastroesophageal reflux disease (GERD) by 24-h pH monitoring: systematic review and meta-analysis
Abstract
Gastroesophageal reflux disease (GERD) is a prevalent and chronic disorder impacting a significant proportion of the global population, approximately 15%. Most GERD patients show improvement with medical treatment, including proton pump inhibitors (PPIs); however, around 40% continue to experience symptoms despite ongoing PPI use. Antireflux mucosal ablation (ARMA) and antireflux mucosectomy (ARMS) are minimally invasive endoscopic procedures for treating GERD. This meta-analysis aimed to evaluate the efficacy of ARMA and ARMS through the DeMeester score, acid exposure time (AET), and clinical success rate. Studies reporting pre- and postprocedure esophageal 24 h pH monitoring following ARMA and ARMS were included. Pooled data analysis assessed changes in the DeMeester score and AET using the standardized mean difference (SMD). Clinical success rate, defined as significant symptom improvement or reduced reliance on PPIs, was also analyzed. Pooled data from three ARMA studies showed a significant postprocedure decrease in median AET (SMD: − 20.74, 95% CI [− 25.51, − 15.97], p < 0.0001). Similarly, six ARMS studies demonstrated a significant reduction in DeMeester score (SMD: − 2.79, 95% CI [− 4.33, − 1.26], p < 0.0001). The overall clinical success rate for ARMS was 78%, while ARMA achieved 87%. Both ARMA and ARMS displayed promising efficacy in improving GERD-related outcomes based on reductions in AET and DeMeester scores and achieving high clinical success rates. However,…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
Read the paper
Related studies
- Advantages and Disadvantages of Long-term Proton Pump Inhibitor Use
- Ivth brazilian consensus conference on helicobacter pylori infection
- A pSMAD/CDX2 complex is essential for the intestinalization of epithelial metaplasia
- S2k-Leitlinie Gastroösophageale Refluxkrankheit und eosinophile Ösophagitis der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – März 2023 – AWMF-Registernummer: 021–013
- Step-by-step management of refractory gastresophageal reflux disease
- Insights into Effects/Risks of Chronic Hypergastrinemia and Lifelong PPI Treatment in Man Based on Studies of Patients with Zollinger–Ellison Syndrome
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.