When every meal leaves you in pain, eating becomes something to fear rather than enjoy. The weight loss that follows can look like an eating disorder to the untrained eye. But for people with superior mesenteric artery syndrome (SMAS), the problem is a rare physical condition that makes eating excruciating rather than a distorted relationship with food. Unfortunately, that distinction is often overlooked by providers unfamiliar with SMAS, leading to months or even years of misdiagnosis.

Read on to learn why the SMAS anorexia misdiagnosis happens so frequently, and where to find the best SMA syndrome treatment specialist in Los Angeles.

What Is SMAS?

SMAS is a rare vascular compression syndrome in which the superior mesenteric artery compresses the duodenum, the first section of the small intestine, between the superior mesenteric artery and the aorta. This compression blocks or slows the movement of food through the digestive tract. The result is a pattern of symptoms that looks, on the surface, a lot like anorexia nervosa: 

  • Chronic nausea after eating
  • Abdominal pain after eating
  • Early satiety or feeling full quickly
  • Food avoidance
  • Weight loss 

Why SMAS Can Be Easily Misdiagnosed

Because SMAS causes extreme food avoidance and weight loss, patients are frequently mislabeled with anorexia. This is because the body's response to duodenal compression, cutting back on food intake to avoid pain, looks behaviorally identical to restrictive eating driven by psychological factors, so clinicians who are not looking for a vascular explanation may never order the imaging needed to find one. 

The Best Diagnostic Tests for Diagnosing SMAS

Getting the right diagnosis starts with asking for the right tests. Standard bloodwork and endoscopy will not identify vascular compression. You need imaging that directly visualizes the relationship between the superior mesenteric artery and the duodenum.

CT angiography for SMAS is currently the most reliable first-line imaging. A CT angiography SMAS study measures the aortomesenteric angle and distance, giving physicians a clear picture of whether compression is present. 

What Happens if SMAS Is Left Untreated?

Without treatment, superior mesenteric artery syndrome can lead to a cycle that becomes increasingly difficult to break. As eating becomes more painful, patients often eat less. Reduced calorie intake can cause additional weight loss, which further decreases the protective fat cushion between the superior mesenteric artery and the duodenum. This can worsen the compression and make symptoms even more severe.

Over a long period of time, untreated SMAS can lead to malnutrition, dehydration, vitamin deficiencies, and a significantly reduced quality of life. Some patients even become unable to maintain a healthy weight or consume enough nutrition to support normal daily activities. In severe cases, hospitalization or temporary feeding tube placement may be necessary to restore nutritional status before additional treatment can be considered.

Can You Have SMAS and an Eating Disorder at the Same Time?

In some cases, SMAS and an eating disorder can exist at the same time. Restrictive eating and other causes of malnutrition can lead to significant weight loss, reducing the mesenteric fat pads that normally cushion the duodenum. As a result, you can first develop an eating disorder and later develop mesenteric artery syndrome when the part of the duodenum becomes compressed between the abdominal aorta and the superior mesenteric artery.

SMAS Treatment Options

Once confirmed, SMAS treatment options range from conservative treatment options to SMA Syndrome surgery, depending on the severity of compression and how long the condition has gone untreated.

For mild to moderate cases, the first step is usually nutritional rehabilitation. Restoring the fat around the aorta and SMA can help reduce compression. This can be done with small, frequent meals, high-calorie supplements, or feeding through a tube that skips the blocked area. Changing positions, like eating while lying on your left side or on your stomach, can also help reduce symptoms during recovery.

When conservative management is not enough, the most common procedure is a duodenojejunostomy, in which the best SMA syndrome treatment specialist in Los Angeles creates a bypass around the compressed segment of the duodenum. 

Who is Most at Risk for Superior Mesenteric Artery Syndrome?

Although superior mesenteric artery syndrome is rare, certain factors can increase the likelihood of developing it. SMAS most often occurs after rapid or significant weight loss, which can reduce the protective fat tissue that normally separates the superior mesenteric artery from the duodenum. As this cushioning decreases, the artery can compress the small intestine, interfering with normal digestion.

Common risk factors include: 

  • Severe illness
  • Trauma
  • Major surgery
  • Eating disorders
  • Chronic medical conditions
  • Any situation that causes substantial weight loss over a short period of time

Additionally, some patients develop SMAS after corrective spinal surgery, particularly when changes in posture alter the angle between the aorta and the superior mesenteric artery.

How to Advocate for Yourself When You Suspect Mesenteric Artery Syndrome

Getting answers can be difficult when you have a rare condition like mesenteric artery syndrome, especially if your symptoms have been attributed to an eating disorder or another diagnosis. If you suspect SMAS, keep a detailed record of your common symptoms, including when pain occurs, whether it is triggered by eating, how severe it becomes, and whether certain positions provide relief. Also, document any unintentional weight loss or significant weight loss, because losing the protective mesenteric fat pads around the abdominal aorta is one of the key risk factors for developing this condition.

Where to Find the Best SMA Syndrome Treatment Doctor in Los Angeles

Superior mesenteric artery syndrome can be overlooked because its symptoms can resemble those of an eating disorder, and in some cases, both conditions may exist at the same time. Whether food avoidance stems from a physical obstruction, a psychological condition, or a combination of both, an accurate diagnosis is essential. 

For patients seeking answers, Dr. Shouhed brings extensive expertise in complex gastrointestinal conditions and minimally invasive surgery. As a nationally recognized, board-certified surgeon and leader in robotic and foregut surgery, Dr. Danny Shouhed takes a patient-centered approach that combines careful diagnostic evaluation with individualized treatment planning. 

Ready to finally get answers to your struggle with pain, weight loss, or difficulty eating with the best SMA doctor in Los Angeles?