Can I Have MALS Symptoms and Not Have MALS?

MALS is a complex diagnosis because the anatomy seen on a scan does not always tell the entire story. Some patients have symptoms that fit MALS closely, while others have overlapping gastrointestinal disorders or additional vascular compression syndromes that may require their own evaluation. And because celiac artery compression can appear on imaging even in people who have no symptoms, it’s important to get evaluated by a MALS expert before undergoing any invasive procedures. 

Continue reading to learn how the best MALS doctor in the United States ensures that your diagnosis is accurate and your treatment is effective.

Why a Positive MALS Scan Doesn’t Always Mean You Have MALS

A scan can show celiac artery compression, but that doesn’t automatically prove that vascular compression is causing your symptoms. MALS only occurs when the median arcuate ligament presses on the celiac artery and nearby nerves. This can cause symptoms such as upper abdominal pain after eating, nausea, vomiting, bloating, diarrhea, food avoidance, and weight loss. The challenge is that celiac artery compression can also occur in people who have no symptoms. 

A MALS diagnosis relies on comparing imaging results with the whole picture:

• Do your symptoms match MALS?
• Does your pain get worse after eating?
• Have you lost weight or started avoiding food because of pain?
• Could another gastrointestinal condition explain your symptoms?
• Does your imaging show significant compression?
• Could another vascular compression syndrome be involved?
• Would treating MALS likely improve your main symptoms?

What Other Vascular Compression Syndromes Can Occur With MALS?

Vascular compression syndromes occur when a blood vessel or nearby structure is compressed. Some can cause symptoms similar to MALS, while others cause very different symptoms. Additionally, some patients with MALS can also have another vascular compression syndrome, especially when their symptoms do not fit the usual MALS pattern. 

What Gastrointestinal Conditions Can Mimic MALS?

Pain after eating is not a unique symptom of MALS. Nausea, vomiting, bloating, feeling full quickly, and weight loss can also occur with many gastrointestinal conditions, including: 

• Gastroparesis, or delayed stomach emptying
• Gastroesophageal reflux disease (GERD)
• Peptic ulcers
• Irritable bowel syndrome (IBS)
• Inflammatory bowel disease
• Gallbladder disease
• Pancreatic disorders
• Celiac disease
• Other problems affecting digestion or gastrointestinal movement

This is why MALS testing must include more than a standard CT scan. Depending on your symptoms, the best MALS doctor in the United States will usually recommend an upper endoscopy, gastric emptying study, ultrasound, CT angiography, or MR angiography.

How Does the Best MALS Doctor in the nation Decide If MALS Surgery Is Appropriate?

The decision to perform MALS surgery is based on symptoms, imaging, and other test results rather than an imaging finding alone. The timing of your pain can also provide important clues. Pain that regularly happens after eating, leads you to avoid food, or has contributed to weight loss may fit the MALS pattern more closely than abdominal pain that occurs randomly. In addition to symptoms, the best MALS doctor in the nation will also recommend or review: 

Vascular Imaging

CT angiography, MR angiography, and mesenteric duplex ultrasound can evaluate the celiac artery and surrounding anatomy. A duplex ultrasound can also show how blood flow changes with breathing, which may provide additional information about the compression.

Gastrointestinal Testing

Tests such as an endoscopy or gastric emptying study can help identify another condition that may be causing your symptoms.

A Celiac Plexus Block

In selected patients, a celiac plexus block may help determine whether the nerves around the celiac artery are contributing to pain.

How Long Does It Take to Recover From MALS Surgery?

Recovery varies from person to person and depends on the surgical approach, your overall health, and whether additional treatment is needed. Some procedures, including MALS release surgery, can be performed using minimally invasive techniques, including laparoscopic and robotic surgery.

Regardless of which MALS surgery you have, it is common to spend about two to three days in the hospital. Additionally, you will need follow-up imaging to check blood flow after surgery. If you lost a significant amount of weight before treatment, nutritional support may also be helpful as you work toward eating normally again.

When Should You See a MALS Specialist for Another Evaluation?

A second opinion can be helpful when your symptoms do not match your MALS diagnosis, your symptoms continue after treatment, or another condition may be involved. 

You should consider seeing the best MALS specialist in the United States if:

• You were diagnosed mainly because of an imaging finding
• Your symptoms do not closely match typical MALS symptoms
• You have ongoing nausea, vomiting, or difficulty eating without a clear explanation
• You have experienced significant unexplained weight loss
• You have urinary, pelvic, flank or leg symptoms that could point to another vascular condition
• Previous gastrointestinal testing has produced conflicting results
• You have been advised to have surgery but do not understand why MALS is considered the cause of your symptoms
• Your symptoms continue after MALS surgery
• Treatment for another gastrointestinal condition has not helped

Where to Find the Top MALS Doctor in the United States

A MALS diagnosis requires careful evaluation and treatment. This means you need to choose a specialist who can look at the entire picture, including your symptoms, vascular anatomy, gastrointestinal health, and the possibility of another condition that could change your treatment plan.

‍Dr. Danny Shouhed brings extensive experience in minimally invasive gastrointestinal and complex general surgery. He trained at Cedars-Sinai and Mount Sinai, served as an administrative chief resident, received national recognition for his surgical research, and has published more than 40 peer-reviewed articles and book chapters. Our focus is on making sure the diagnosis makes sense before recommending treatment. 

Ready to get an accurate diagnosis and treatment plan from the best MALS treatment specialist in the United States?