You eat a meal, and soon afterward, the pain begins. Maybe it sits beneath your ribs, spreads toward your back, or makes you nauseated. While gallbladder disease is a common reason for these symptoms, median arcuate ligament syndrome (MALS) can produce similar upper abdominal symptoms and may be overlooked when another abnormality is easier to find. Because MALS is rare, affecting an estimated two people per 100,000, getting an accurate diagnosis often requires an expert. 

Continue reading to learn more about how MALS can mimic gallbladder disease and where to find the best MALS doctor in Los Angeles for effective treatment.

What Does MALS Pain Feel Like?

MALS pain often has a predictable correlation with eating. Many people describe aching, pressure, burning, or severe pain in the upper abdomen that begins after a meal. Some develop nausea, vomiting, bloating, or diarrhea. Over time, eating can become associated with so much discomfort that you might start unconsciously eating less food or avoid certain foods. This can cause intentional weight loss that, in some cases, can be misdiagnosed as an eating disorder. 

The reason MALS can be confusing is that these symptoms are not unique to vascular compression syndrome. Gastritis, ulcers, reflux, gastroparesis, pancreatic disorders, and gallbladder disease can all produce similar upper abdominal symptoms.

How Is Gallbladder Pain Different From MALS?

While gallbladder disease has its own recognizable pattern of symptoms, there is considerable overlap between gallstone symptoms and MALS:

Symptom MALS Gallbladder Disease
Typical location Upper-middle abdomen Upper-right or upper-middle abdomen
Common trigger Eating, sometimes exercise Often meals, particularly fatty meals
Radiation May extend into the back May extend to the back or right shoulder
Other symptoms Nausea, bloating, diarrhea, food avoidance, weight loss Nausea, vomiting, indigestion
Diagnostic testing Mesenteric Doppler ultrasound, CTA/MRA and sometimes celiac plexus block Abdominal ultrasound, blood tests and sometimes HIDA scan, CT or MRCP

How Can You Tell MALS Symptoms and Gallbladder Disease Symptoms Apart?

MALS typically causes upper-middle abdominal pain that repeatedly occurs after eating, sometimes accompanied by nausea, bloating, diarrhea, food avoidance, and unintended weight loss. Gallbladder disease causes the same type of pain and GI symptoms, but most of the time the pain is located in the upper-right or upper-middle abdomen, frequently after a fatty meal, and can radiate to the right shoulder or back. Symptoms alone cannot distinguish MALS from gallbladder disease. You need a careful history, physical examination, and special imaging that looks for gallstones, gallbladder dysfunction, or celiac artery compression. 

What Tests Are Used to Diagnose MALS?

MALS is generally a diagnosis reached after other causes of upper abdominal pain have been investigated. When MALS is suspected, GI doctors begin with blood tests, an abdominal ultrasound, upper endoscopy, or other gastrointestinal testing depending on the symptoms. Specialized vascular imaging can also help. This includes: 

  • Mesenteric duplex ultrasound: This type of ultrasound can evaluate blood flow through the celiac artery and assess changes associated with breathing. 
  • CT angiography or magnetic resonance angiography: This imaging can show the anatomy of the celiac artery and whether it has the characteristic narrowing associated with median arcuate ligament compression.
  • A celiac plexus block: This procedure can temporarily numb nerves around the celiac artery to see if the characteristic pain improves substantially. That response can help determine whether releasing the median arcuate ligament is likely to provide benefit.

In contrast, a gallbladder evaluation follows a different pathway. An abdominal ultrasound is commonly the first imaging test for gallstones. Depending on the clinical situation, doctors may use liver and pancreatic blood tests, a HIDA scan, CT, MRCP, or other testing to confirm diagnosis. 

When Should You See a MALS Specialist in Los Angeles?

You should consider a specialist evaluation if you have persistent upper abdominal pain, particularly if it consistently follows meals and the usual gastrointestinal or gallbladder evaluation has not explained it. A MALS-focused evaluation is especially important when:

  • Pain repeatedly begins after eating
  • You have started avoiding food because you expect it to hurt
  • You have unexplained weight loss
  • You have nausea, bloating, or diarrhea along with the pain
  • Gallbladder testing is normal, but symptoms continue
  • Gallstones are present, but your symptoms do not fit the usual gallbladder pattern
  • You have already undergone treatment for presumed gallbladder disease without meaningful improvement
  • Imaging has identified celiac artery compression, and your symptoms are consistent with MALS

If you have severe or rapidly worsening abdominal pain, do not assume the cause is MALS. Severe persistent pain, fever, chills, jaundice, repeated vomiting, or significant abdominal tenderness can signal gallbladder complications or another urgent condition and warrant prompt medical evaluation.

What is the Best Treatment for MALS in Los Angeles?

When symptoms, testing, and clinical evaluation support a MALS diagnosis, treatment generally involves surgery for median arcuate ligament release. This minimally invasive procedure releases the ligament compressing the celiac artery and nearby nerves. Laparoscopic surgical techniques are the most common approach for this type of surgery, but open surgery may be necessary in some cases.

Where to Find the Best MALS Doctor in Los Angeles

Persistent upper abdominal pain can be difficult to diagnose, even for the most experienced GI doctor. That is why choosing an expert in MALS and gallbladder disease matters. 

In Southern California, Dr. Shouhed offers extensive experience in minimally invasive gastrointestinal and complex general surgery, including evaluating challenging abdominal conditions. He trained at Cedars-Sinai and Mount Sinai, served as administrative chief resident at Cedars-Sinai, and holds leadership roles in minimally invasive and robotic surgery. He has also published more than 40 peer-reviewed articles and chapters and has taught advanced robotic techniques to surgeons nationally. This level of expertise is what patients across the nation look for when dealing with complex gastrointestinal conditions or ongoing symptoms. 

Ready to see the best MALS doctor in Los Angeles for an accurate diagnosis and the most advanced treatment in the United States?