That hot, sour burn that creeps up your throat after a meal can make you dread bedtime or even taking the next bite. If this happens often, you might assume it’s gastroesophageal reflux disease, also known as GERD, and that makes sense because researchers estimate about 20% of people in the United States experience chronic acid reflux. But for a small subset of people, this recurring acid reflux may actually be caused by median arcuate ligament syndrome, or MALS. This condition is caused by a ligament pressing on nerves and blood vessels that can worsen during or after a meal. 

If you’ve tried the usual acid reflux treatments and still feel that tight, persistent discomfort after eating, this article can help by explaining the differences and similarities between MALS and GERD symptoms and where to find the best MALS treatment doctor in Los Angeles.

What is MALS? 

Median arcuate ligament syndrome, or MALS, is a rare vascular condition where a tight band of tissue under the diaphragm, the median arcuate ligament, presses on the celiac artery and can also irritate the nearby nerve bundle called the celiac plexus. It causes symptoms such as: 

  • Upper abdominal pain after eating or exercising.
  • Burning sensations in the stomach or upper abdomen 
  • Nausea, vomiting, bloating, diarrhea, and unintended weight loss
  • Symptoms that worsen after eating spicy foods

MALS pain can feel like a deep squeezing sensation, sharp abdominal cramping, or a tight knot in the upper abdomen. Because symptoms overlap, MALS is often misdiagnosed as a peptic ulcer, irritable bowel syndrome (IBS), or gastroesophageal reflux disease (GERD). 

MALS vs. GERD: Symptoms Similarities 

Classic GERD symptoms include heartburn and acid regurgitation, like a burning behind the breastbone or sour liquid backing up into your throat. These symptoms usually worsen at night, after lying down, after eating, or when certain foods trigger them. 

But for many people, GERD can cause dyspepsia-type symptoms like nausea, bloating, feeling full quickly, an occasional wave of nausea after eating, or excessive burping after meals. MALS patients experience postprandial abdominal pain that often begins after meals or during physical activity, closely mimicking GERD. This pain can get bad enough that you’d rather skip meals because you do not want to trigger it again. Over time, that fear of eating can lead to unintentional weight loss. 

How is MALS Diagnosed?

MALS can be difficult to diagnose, and it is often diagnosed after other conditions are ruled out. This usually includes a detailed physical examination, thorough evaluation of your medical history, and an upper endoscopy to look for irritation or damage of the esophagus or stomach lining. To rule out GERD, an esophageal pH test can also help by measuring the amount of acid that backs up into the esophagus. 

To confirm the diagnosis of MALS, an ultrasound-breathing test is typically recommended. During this test, you are asked to breathe in and out on command while an ultrasound monitors the blood flow in your celiac artery. CT angiography or MR angiography can also help diagnose celiac artery compression. 

What are the Best Treatment Options for MALS? 

Surgical treatment for MALS focuses on relieving pressure where the median arcuate ligament compresses the celiac artery and often irritates nearby nerves. The most common approach is surgical decompression, called median arcuate ligament release. In some cases, the surgeon may also address nearby nerve tissue or blood vessel narrowing.

Discover the Best MALS Treatment Doctor in Los Angeles

When a few bites can flip your stomach into a tight, gripping ache that makes you set the fork down, you need a surgeon whose expertise can give you fast, long-lasting relief. 

Patients in Los Angeles and beyond trust Dr. Danny Shouhed as the leading MALS expert in the country, thanks to his extensive background and board-certified affiliation with Cedars-Sinai. Dr. Shouhed is recognized for his leadership in robotic surgery training and programs, and his clinical focus includes rare conditions like MALS, where symptoms can overlap with other GI disorders. 

Ready to get an accurate diagnosis and minimally invasive surgery options from the best MALS treatment doctor in Los Angeles?