For a number of people, especially young women, developing food anxiety when most foods lead to pain and nausea can be misdiagnosed as an eating disorder. However, there is another possible answer. Median arcuate ligament syndrome, or MALS, is a rare vascular condition in which a band of fibrous tissue called the median arcuate ligament sits abnormally low and presses against the celiac artery, cutting off blood flow to the digestive organs. 

When that compression occurs, patients develop intense pain in the upper abdomen after eating. This pain can be so severe that many people stop eating altogether out of fear of triggering it. When nausea, vomiting, and rapid weight loss follow suit, these symptoms mimic an eating disorder and often lead to misdiagnosis. 

Read on to learn more about the symptoms of MALS and where to find the best MALS treatment doctor in Los Angeles.

Why MALS Can be Easy to Miss

Most people, including many primary care physicians, have never heard of median arcuate ligament syndrome, and that is part of why it often gets misdiagnosed. MALS affects approximately two per 100,000 people, and young adult women make up the majority of those diagnosed. That demographic overlaps with eating disorder populations, and is one of the first reasons the wrong diagnosis gets made. 

How Do MALS Symptoms Mimic an Eating Disorder?

Because pain, nausea, vomiting, weight loss, diarrhea, and fatigue are symptoms shared by several upper gastrointestinal conditions, the risk of misdiagnosis is high, and comprehensive medical workups often come back unrevealing except for compression of the celiac artery on imaging. 

In other words, every standard test can look normal until the best MALS expert in Los Angeles orders the right one. MALS is considered a diagnosis of exclusion, meaning it is generally only considered after a patient has already gone through upper endoscopy, colonoscopy, and evaluation for gallbladder disease and gastroesophageal reflux disease (GERD). By the time a vascular cause is even entertained, many patients have been living with the wrong label for months or years.

The hallmark symptom of MALS is upper abdominal pain that strikes after eating, and the pain can be intense enough that patients become afraid to eat for fear of triggering it. That fear is a rational, learned response to a real physical threat. But to a clinician who is not thinking vascularly, food avoidance in young people, especially women, signals a mental health concern before it signals a compressed artery. 

How Is MALS Diagnosed

One reason MALS goes undetected for so long is that the tests needed to confirm it are not part of a standard gastrointestinal workup. Endoscopies, colonoscopies, blood panels, and psychiatric evaluations can still lead to a dead end in terms of a definitive diagnosis. This is because standard imaging usually can’t detect MALS. 

The compression of the celiac artery that causes MALS can only be detected using noninvasive vascular imaging, including duplex arterial ultrasound, CT angiography, or MR angiography. Additionally, these test results rely on respiratory maneuvers because the compression is typically worse when the patient breathes out fully. A standard abdominal ultrasound done without respiratory instructions can miss the compression entirely, which means a negative result does not always mean MALS is absent. The gold standard for diagnosis is a three-dimensional CT angiography imaging test.

Treatment Options for MALS

Once MALS is correctly diagnosed, surgical treatment is necessary. For many patients, MALS surgery improves quality of life by bringing relief that years of therapy and dietary restriction never did. The standard surgical approach with the best MALS doctor in Los Angeles is laparoscopic, in which the surgeon divides the median arcuate ligament and releases the pressure on the celiac artery and surrounding nerves. Most patients stay one night in the hospital and are able to eat and drink normally the following morning. 

Where to Find the Best MALS Treatment Doctor in Los Angeles 

Dr. Danny Shouhed is one of the few surgeons in the country who has built his practice around rare vascular conditions like MALS and SMAS. These frequently missed conditions can be life-altering when misdiagnosed or left untreated. At our state-of-the-art Beverly Hills office, we work with patients across the nation who want an accurate diagnosis and personalized treatment plans that provide lasting relief.

Ready to get the best MALS treatment in Los Angeles?