Median Arcuate Ligament Syndrome (MALS) is a condition that often affects the digestive system, causing various symptoms. This article explains MALS symptoms for a general audience.
What is MALS
Median Arcuate Ligament Syndrome, often referred to as MALS, occurs when the median arcuate ligament compresses the celiac artery. The median arcuate ligament is a fibrous band located in the diaphragm, a muscle that plays a role in breathing. This compression occurs as the ligament passes over the celiac artery, a major blood vessel supplying the stomach, liver, spleen, and parts of the pancreas and small intestine. The pressure reduces blood flow to these abdominal organs. This reduced blood flow, or ischemia, causes the various symptoms of MALS.
Common Symptoms of MALS
Upper abdominal pain is a common symptom of MALS, ranging from mild discomfort to severe, cramping sensations. This pain often worsens after eating or during exercise, as these activities increase the demand for blood flow to the digestive organs. The location of the pain is typically in the epigastric region, just below the breastbone. Some individuals may describe the pain as aching or pressure-like.
Unintended weight loss is another common symptom. This often results from sitophobia, a fear of eating due to post-meal pain. The discomfort leads to reduced food intake and significant weight loss. Nausea, sometimes with vomiting, also impacts nutrition and worsens weight loss.
Less Common Symptoms
While abdominal pain, weight loss, and nausea are common, MALS can also present with less frequent symptoms. Some individuals may experience changes in bowel habits, such as diarrhea or constipation. These gastrointestinal disturbances reflect the varied impact of reduced blood flow on different parts of the digestive system. Fatigue is another symptom, often due to chronic pain, nutritional deficiencies from reduced food intake, or the body’s response to compromised blood flow.
In some cases, a doctor might detect an abdominal bruit during a physical examination. This is a whooshing sound heard with a stethoscope over the upper abdomen, caused by turbulent blood flow through the narrowed celiac artery. The presence of a bruit can be a clue, though it is not always present and can be found in other conditions. The overall presentation of MALS can vary significantly among individuals, making diagnosis challenging.
How MALS Symptoms are Identified
Identifying MALS symptoms begins with a thorough medical history and physical examination. Doctors will inquire about the nature, duration, and triggers of abdominal pain, as well as any associated symptoms like weight loss or changes in bowel habits. Understanding the patient’s symptom pattern, especially pain related to eating, is important for considering MALS. The physical examination may include listening for an abdominal bruit.
Diagnostic imaging tests confirm MALS. Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are used to visualize the celiac artery and assess for compression. These tests show artery narrowing and help rule out other conditions. Duplex ultrasound is a non-invasive imaging technique that measures blood flow velocity through the celiac artery. It provides dynamic information about the compression and its effect on blood flow, especially during breathing maneuvers.
When to Seek Medical Advice
If you experience persistent or recurring upper abdominal pain, especially if it worsens after eating or is accompanied by unexplained weight loss, seek medical attention. Other concerning symptoms like chronic nausea, vomiting, or significant changes in bowel habits also warrant a professional evaluation. Consulting a healthcare provider is important for diagnosis and management. Early MALS diagnosis can lead to more effective symptom management and improved well-being.
What is MALS
Median Arcuate Ligament Syndrome, often referred to as MALS, occurs when the median arcuate ligament compresses the celiac artery. The median arcuate ligament is a fibrous band located in the diaphragm, a muscle that plays a role in breathing. This compression typically happens as the ligament passes over the celiac artery, which is a major blood vessel supplying blood to the stomach, liver, spleen, and parts of the pancreas and small intestine. The pressure on the artery can reduce blood flow to these abdominal organs, and it may also put pressure on nearby nerves. Reduced blood flow, or ischemia, to these organs can lead to the various symptoms experienced by individuals with MALS.
Common Symptoms of MALS
One of the most frequently reported symptoms of MALS is upper abdominal pain, which can range from mild discomfort to severe, cramping sensations. This pain often worsens after eating or during exercise, as these activities increase the demand for blood flow to the digestive organs. The location of the pain is typically in the epigastric region, just below the breastbone. Some individuals may describe the pain as aching or pressure-like.
Another common symptom associated with MALS is unintended weight loss. This often occurs because individuals may develop a fear of eating, known as sitophobia, due to the pain that follows meals. The discomfort after eating can lead to reduced food intake, contributing to significant weight loss over time. Nausea is also a common complaint, sometimes accompanied by vomiting, which further impacts nutritional intake and can exacerbate weight loss.
Less Common Symptoms
While abdominal pain, weight loss, and nausea are prominent indicators, MALS can present with other, less frequent symptoms. Some individuals may experience changes in bowel habits, such as diarrhea or constipation. These gastrointestinal disturbances reflect the varied impact of reduced blood flow on different parts of the digestive system. Fatigue is another symptom reported by some patients, possibly due to chronic pain, nutritional deficiencies from reduced food intake, or the body’s response to compromised blood flow.
In some cases, a doctor might detect an abdominal bruit during a physical examination. This is a whooshing sound heard with a stethoscope over the upper abdomen, caused by turbulent blood flow through the narrowed celiac artery. The presence of a bruit can be a clue, though it is not always present and can be found in other conditions. The overall presentation of MALS can vary significantly among individuals, making diagnosis challenging.
How MALS Symptoms are Identified
Identifying MALS symptoms begins with a thorough medical history and physical examination. Doctors will inquire about the nature, duration, and triggers of abdominal pain, as well as any associated symptoms like weight loss or changes in bowel habits. Understanding the patient’s pattern of symptoms, particularly pain related to eating, is a key step in considering MALS. The physical examination may include listening for an abdominal bruit.
Diagnostic imaging tests are crucial for confirming the presence of MALS. Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are commonly used to visualize the celiac artery and assess for compression. These tests can show the narrowing of the artery and help rule out other conditions. Duplex ultrasound is another non-invasive imaging technique that can measure blood flow velocity through the celiac artery, providing dynamic information about the degree of compression and its effect on blood flow, especially during breathing maneuvers.
When to Seek Medical Advice
If you are experiencing persistent or recurring upper abdominal pain, especially if it worsens after eating or is accompanied by unexplained weight loss, it is advisable to seek medical attention. Other concerning symptoms like chronic nausea, vomiting, or significant changes in bowel habits also warrant a professional evaluation. Consulting a healthcare provider is important for proper diagnosis and management. Early diagnosis of conditions like MALS can lead to more effective strategies for managing symptoms and improving overall well-being.