Do you feel a strange pain in your upper stomach after eating? Sometimes the pain is so severe that you're afraid to eat, right? Many people face this experience. Today, we're going to talk about a condition that can cause these symptoms, but it's not very common.
What is Median Arcuate Ligament Syndrome (MALS)?
Okay, so what is Median Arcuate Ligament Syndrome? Simply put, it is a condition caused by a tissue called the 'Median Arcuate Ligament' in our chest, pressing on the 'Celiac Artery' , a major blood vessel that carries blood to our stomach, and the 'Celiac Plexus' , a nearby nerve system.
Imagine, this 'median arcuate ligament' is like an arch. It is located around our 'aorta' , the main blood vessel that carries blood from the heart to the entire body. The 'celiac artery' is an important branch that branches off from this 'aorta'.
Normally, this 'median arcuate ligament' should be above the 'celiac artery'. But in someone with (MALS), this ligament may be located lower than normal. What happens then? This ligament compresses the 'celiac artery'. Just like when someone squeezes a water pipe, the water stops flowing, the blood flow through this blood vessel is disrupted. Not only that, but the nearby nerves can also be compressed.
This is why you get a sharp pain in your upper stomach after eating. Sometimes the pain is so severe that you are afraid to eat because you think it will be difficult again. (MALS) is also called:
- (Celiac Artery Compression Syndrome)
- (Celiac Axis Compression Syndrome)
- (Dunbar Syndrome)
What are the symptoms of (MALS)?
Now let's look at the symptoms of (MALS). The main one is pain in the upper abdomen after eating . This is the first symptom that appears. Some people say that this pain is so severe that they are afraid to eat, for fear that the symptoms will reappear. There are other symptoms, some of which are:
- Bloated stomach
- Going to the stomach, that means diarrhea ((Diarrhea))
- Nausea and vomiting
- Weight loss for no apparent reason, perhaps 20 pounds or more.
What are the causes of (MALS)?
Experts still don't know exactly what causes MALS. Some researchers say that some people are born with an abnormally formed median arcuate ligament. Others believe that MALS can develop as a complication of abdominal surgery, spinal surgery, or severe abdominal trauma.
What are the possible complications of (MALS)?
Often, people with MALS go undiagnosed for months, even years. Imagine, they live with chronic pain during that time. This ongoing pain can lead to mental health problems. For example, depression . Also, when a diagnosis is not made despite multiple tests and no treatment is available, it can cause significant anxiety .
Imagine there is a person named Nalini, who has a stomach ache every time she eats. When she goes to the doctors, they do one test after another, but the disease is not detected. Some even say, 'You must have a mental problem.' Then how sad and anxious Nalini must be, right? This kind of experience (MALS) can be common for people with it.
How do doctors diagnose (MALS)?
Okay, so how do doctors find out if you have MALS? If your doctor suspects that you have MALS, he or she will first take a complete medical history and then do a physical exam .
Now, there are many conditions that can cause upper abdominal pain. For example, it could be anything from appendicitis to gastroparesis to conditions like peptic ulcer disease. So, your doctor will first order various blood tests and imaging tests to rule out these common conditions that could be causing your symptoms.
Blood Tests
The doctor may order one or more blood tests, such as:
- Complete Blood Count (CBC)
- Comprehensive Metabolic Panel
- Liver Function Tests
- A (SED rate test) or (C-reactive protein - CRP test) to check for inflammation in the body
- Thyroid tests - This may include blood tests as well as imaging tests.
Imaging Tests
- Abdominal Ultrasound
- A small bowel follow-through test
- Upper GI series examination
Special testing procedures
- A colonoscopy, which examines the large intestine
- Esophagogastroduodenoscopy (EGD) / Upper Endoscopy, which examines the esophagus, stomach, and beginning of the small intestine
- Motility studies measure how quickly food moves through the digestive system.
If these tests rule out common conditions, your doctor may refer you to a gastroenterologist for more specialized tests. Some of these include:
- Angiogram - This checks the condition of the blood vessels.
- A computed tomography scan ((Computed Tomography - CT scan)) examination
- A magnetic resonance imaging (MRI) scan
- Mesenteric Duplex Ultrasound - This specifically looks at how blood flows through your celiac artery, or whether the nerves called the celiac plexus are being squeezed by that ligament.
"All of these tests are done to find out exactly what the problem is. Sometimes this can take a while, but it's important to be patient until you get the right diagnosis."
How is (MALS) treated?
Okay, now that you've been diagnosed with MALS, what are the treatments? Your doctor may recommend a 'celiac plexus block' to help relieve your abdominal pain. This is like an injection into the painful nerve, temporarily disabling some of the nerves and reducing the pain.
In addition, the main treatment is a surgery called 'median arcuate ligament release' . This surgery involves cutting and removing or loosening the tight ligament. This relieves the pressure on the 'celiac artery' and nerves. After this surgery, blood flow through the 'celiac artery' is restored, and the pressure on the nerves is also relieved.
The medical team that treats (MALS)
(MALS) is a rare condition. And because it can cause both physical and mental health problems, there is likely a team of specialists to help you. These may include:
- Gastroenterologists (specialists in gastrointestinal diseases)
- General Surgeons
- Vascular Surgeons
- Pain Management Specialists
- Psychiatrists or psychologists
- Dietitians
All of these people are working together to provide you with relief. Imagine, each one helping you with your problem in a different way.
What kind of things can be expected if there is (MALS)?
After surgery, symptoms often subside. That's true. However, some studies have shown that even after surgery, Median Arcuate Ligament Syndrome (MALS) can recur. There's nothing we can do to prevent it from happening. However, it's important to be aware of other changes in your body that could be signs that MALS is coming back . Ask your doctor what these early warning signs are. He or she will explain to you what to look out for.
When should you seek medical advice?
We mentioned that MALS symptoms can recur even after surgery. If that happens, you should definitely let your medical team know.
Imagine, you know that there is something wrong with your stomach. You experience unbearable pain in the upper part of your stomach after every meal. But despite continuous testing, you have not been able to find out what the problem is or what the treatment is for it. You may have even heard that these symptoms are caused by a psychological problem rather than a physical one. At a time like this, when you learn that this rare condition (Median Arcuate Ligament Syndrome) is the cause of your symptoms, you will feel a great sense of relief, right?
Even better, there are treatments to help ease your pain. Your doctor may recommend surgery. If the diagnosis is MALS, your medical team will recommend the right treatment for you to help you enjoy food and life again.
The most important things we need to remember from this story are
- Severe pain in the upper abdomen after eating can be a key symptom of MALS.
- This happens because the 'median arcuate ligament' compresses the 'celiac artery' and its associated nerves.
- Several tests need to be done to make a diagnosis, as this is a relatively rare condition and other common diseases need to be ruled out.
- The main treatment is surgery, but there are other treatments for pain, such as celiac plexus block.
- If symptoms return after treatment, it is very important to seek medical advice without delay.
- Living with this condition is difficult, so emotional support is also very important . Remember that you are not alone. Your doctors, family, and friends will help you on this journey.
` Median Arcuate Ligament Syndrome, MALS, Abdominal Pain, Pain After Eating, Celiac Artery, Surgery, Digestive System
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