Experiencing strange symptoms like your stomach burning after every meal, losing weight you weren't trying to lose, and unexplained nausea is frustrating. People with these symptoms and normal test results often get misdiagnosed with conditions like acid reflux or anxiety, but treatments for these conditions are not successful. If this sounds familiar to you, you could be dealing with one of two rare conditions: Median Arcuate Ligament Syndrome (MALS) or Superior Mesenteric Artery Syndrome (SMAS). 

These conditions affect the blood vessels and arteries in your abdomen, cutting off normal blood flow or compressing your small intestine in ways that cause relentless, hard-to-pin-down pain. Both conditions are frequently overlooked, partly because their symptoms look so much like common digestive problems, and partly because most doctors simply haven't seen them before. 

Research shows that patients with rare diseases go through around 14 diagnostic tests before getting a confirmed diagnosis, causing an average delay of care close to four years. That kind of wait can have a profound effect on your health and your daily life. 

Continue reading to learn more about MALS and SMAS, and where to find the most effective treatments with the best SMA syndrome treatment doctor in Los Angeles.

MALS vs. SMAS: Similarities and Differences

Understanding the differences and similarities of MALS compared to SMAS can help you understand why these two conditions can be difficult to diagnose until you begin working with the best MALS doctor in Los Angeles, who is an expert in both conditions. 

  • MALS happens when the median arcuate ligament presses against the celiac artery and the nearby bundle of nerves called the celiac plexus. The celiac artery is one of the main blood vessels that supplies blood to your stomach, liver, spleen, and other digestive organs, so when it gets squeezed, your body feels it every time you try to eat. 
  • SMAS is a separate but related condition where the aorta and the superior mesenteric artery (SMA) compress the duodenum, which is the first section of the small intestine that connects directly to your stomach. In SMAS, that tube gets pinched shut by surrounding arteries, making it hard for food to move through normally. 

Both conditions are considered rare, with MALS affecting roughly two out of every 100,000 people. Symptoms of both conditions can easily be mistaken for more common digestive conditions, like:

  • Irritable bowel syndrome
  • Acid reflux
  • An eating disorder
  • GERD
  • Achalasia
  • Peptic ulcer disease
  • Gastritis
  • Gastroparesis
  • Gallbladder disease

Symptoms of MALS and SMAS

Both of these medical conditions share symptoms like:

  • Nausea
  • Vomiting
  • Bloating
  • Fatigue after eating
  • Unexplained weight loss

However, pain can often feel slightly different between the two conditions. With MALS, pain is typically felt between the ribs and below the sternum, and it can spread to the sides, back, and chest. Many patients become unable to eat because of the pain and nausea, which leads to significant weight loss over time. The pain often starts within 15 to 30 minutes of finishing a meal, and over time, the body begins to connect eating with discomfort. Many times, people start eating smaller amounts of food, skipping meals, or cutting out foods they once enjoyed because eating hurts. MALS symptoms can come and go, often changing with physical activity and body position.

SMAS symptoms vary from mild to severe, tend to start or get worse right after eating, and can be especially uncomfortable after meals that are high in fiber. What separates these conditions from ordinary digestive trouble is how persistent and progressive the symptoms are. 

How Are MALS and SMAS Diagnosed?

Both MALS and SMAS are considered diagnoses of exclusion, which means more common gastrointestinal conditions should be ruled out before landing on an accurate diagnosis. Tests such as upper endoscopy, colonoscopy, motility studies, and gastric emptying tests are often used to confirm their diagnosis. 

  • For MALS, a duplex arterial ultrasound is usually the first imaging step, followed by CT angiography with breathing maneuvers on both inhalation and exhalation, which helps show how much the artery is being compressed at different points in the breathing cycle. 
  • For SMAS, the most common diagnostic tool is a CT angiogram, which allows the best SMAS doctor in Los Angeles to measure the aortomesenteric angle to confirm whether compression is actually happening.

When is Surgery Necessary for MALS and SMAS?

Not everyone with MALS or SMAS needs surgery, but for many patients, it becomes the only option that brings real, lasting relief. If you want to try conservative treatments first, treatment options for MALS include dietary changes and pain management strategies. 

At least 70% of cases of SMAS can be managed with non-surgical treatment, with the goal of restoring weight and rebuilding the fat cushion between the arteries that keeps the duodenum from being pinched. Weight restoration through nutritional support, tube feeding, or IV nutrition are great options to start with.

When conservative treatment does not work, or when symptoms are severe enough from the start, surgery is the best path for effective relief. 

  • For MALS, the most effective treatment is surgery to release the pressure from the median arcuate ligament, most often through minimally invasive laparoscopic or robotic-assisted techniques. During the procedure, the best MALS doctor in Los Angeles carefully cuts the ligament to relieve compression on the celiac artery, and in some cases also removes certain nerves in the area to reduce ongoing pain. 
  • For SMAS, procedures like the laparoscopic duodenojejunostomy have largely replaced open surgery as the preferred approach, with reported success rates over 80%, reduced postoperative pain, and a lower risk of complications compared to traditional open procedures. In a duodenojejunostomy, a new connection between the small intestine and the section of the duodenum beyond the blockage bypasses the compressed area entirely. 

Robotic surgery is also an option at specialized centers, offering a minimally invasive and highly precise approach to relieving the compression caused by either MALS or SMAS. 

What to Expect During Recovery After MALS or SMAS Surgery

Recovery looks different for everyone, but knowing what a realistic timeline feels like can help you plan for it:

  • MALS patients can expect a typical hospital stay of around three days, during which the care team focuses on pain management, nutrition, and making sure the body is healing before discharge. Light activities like walking are usually encouraged within a few weeks, but full recovery can take a few months. The first few weeks at home often involve dietary adjustments that reintroduce foods gradually, working with a physical therapist to rebuild strength, and scheduling follow-up imaging to confirm that blood flow through the celiac artery has improved. 
  • SMAS patients recovering from minimally invasive surgery can expect a short hospital stay or an outpatient procedure. Post-operative care focuses on managing post-operative pain and ensuring a return to normal digestive function. 

One thing many patients are not fully prepared for is that improvement can be gradual. The body has often been under stress for months or years, and the digestive system needs time to recalibrate. Some people notice a clear difference within a few weeks of surgery, while others can take longer, particularly if significant weight loss or nerve inflammation was part of their experience. Either way, working with the best MALS specialist in Los Angeles can improve your chances of a full recovery and reduce your risks of surgical complications. 

Finding the Best MALS Treatment Doctor in Los Angeles 

Living with unexplained stomach pain is exhausting in a way that is hard to describe to someone who hasn't been through it. Dr. Danny Shouhed is a board-certified minimally invasive surgeon based in Los Angeles who has built his practice around complex gastrointestinal conditions, including MALS and SMAS. He uses robotic surgical technology to operate with a level of precision that is difficult to achieve through traditional open approaches, which matters in a part of the body where the arteries, nerves, and organs are packed tightly together and the margin for error is small. 

We understand that you may have already seen multiple specialists and tried multiple treatments. This is why Dr. Shouhed and his team are committed to providing accurate answers and precision treatments.

Ready to start getting real answers and an effective treatment plan from the best MALS treatment doctor in Los Angeles?