Symptoms
MALS symptoms manifest as numerous gastrointestinal complaints and can range from intermittent mild to chronic debilitating that are triggered after eating or exercise. It is still commonly considered a diagnosis of exclusion, so patients are usually sent for many tests most of which turn out “normal.” Unfortunately, MALS symptoms can all too often be dismissed by clinicians as non-specific, psychosomatic, or psychiatric, leaving many patients to suffer for months and years longer than they need to. Clinical presentation varies and is case specific to each person's symptoms.
Common symptoms experienced after eating, exercise, positional movement
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Epigastric Pain or Pressure
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Postprandial Pain or Pressure
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Chest Pain or Pressure
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Nausea
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Vomiting
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Diarrhea
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Constipation
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Bloating
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Weight loss
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Radiating Flank
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Back Pain
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Blood Pressure Issues
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Dizziness
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Orthostasis
Cascading Symptoms
These symptoms are a result of the disease process associated with MALS. They are associated with issues occurring in the diaphragm.
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Neck Pain
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Shoulder Pain
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Back Pain
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Difficulty Breathing
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Tachycardia
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Neck Stiffness
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Shoulder Stiffness
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Back Stiffness
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Difficulty Sleeping
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Fatigue
Primary Testing
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Duplex or Doppler Mesenteric Ultrasound with breathing protocol (inspiration and expiration)
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Computed Tomography Angiography (CTA) with breathing protocol (inspiration and expiration)
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Catheter Abdominal Angiography with Contrast Dye
Diagnostic Tests
MALS is still considered a diagnosis by exclusion. This may result in you having the following tests done as well as the primary testing associated with MALS.
Tests may include:
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Magnetic Resonance Angiography (MRA)
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CT scan with or without Contrast Dye
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Gastric Emptying Study with Small Bowel Follow Through
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HIDA Scan of Gallbladder
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Endoscopy (EGD)
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Colonoscopy with Biopsies
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24 hr pH Impedance Probe
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Esophageal Manometry
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Gastric Tonometry
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Blood Work Panels
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Chest X-Ray
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Stool Tests
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Electrocardiogram (EKG)
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Celiac Plexus Block (CPB)
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Splanchnic Nerve (SNB)
Management & Surgical Treatment
The standard treatment is surgical release of the celiac artery by division of the median arcuate ligament (MAL). This includes overlying lymphatics and soft tissue with or without neurolysis of the compressed nerves and removal of scar tissue.
When surgery is not an option due to risk factors outweighing the benefits, a comprehensive conservative approach may be incorporated to help with symptom management.
​Surgical Options:
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Laparotomy (open)
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Laparoscopic
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Robotic
Additional Intervention offered after Surgical Release:​
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Reconstruction
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Balloon Angioplasty
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Stent Placement
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Nerve Removal
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Nerve Ablation​
Comorbidities
MALS patients are incredibly unique, even within our community. Even though we all suffer from MALS, our presentations and symptoms can be completely different from one another. That being said, some other conditions are common within our community.
Vascular Conditions:
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Superior Mesenteric Artery Syndrome (SMAS)
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Nutcracker Syndrome (NCS)
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May Thurner Syndrome (MTS)
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Pelvic Congestion Syndrome (PCS)
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Thoracic Outlet Syndrome (TOS)
Other Conditions:
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Pancreatitis
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Gastroparesis (GP)
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Postural Orthostatic Tachycardia Syndrome (POTS)
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Ehlers Danlos Syndrome (EDS)
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Mast Cell Activation Syndrome (MCAS)
Finding Support
There are a few support groups specifically for MALS patients. They are all over social media. You can find the MALS community on Facebook, Instagram, TikTok, and Reddit. If you are looking for a person-to-person support group, the most popular one is on Facebook; it's called MALS Pals. Most support groups include both MALS patients and their caregivers, so you can hear about the MALS experience from each side. These groups were created to help us find each other, but they have also become a haven for us to share our journeys.
They aren’t always happy stories, but it does help to share and read about fellow experiences. Please note that we are not affiliated with this group. If any issues arise within the group, please contact the administrators.
If you don’t use social media but still support us, we are always available to talk one-on-one with you via email.