Median Arcuate Ligament Syndrome (MALS)

I just read the article you mentioned. Very interesting. I have been reading about this 'gold standard' for sibo testing the jejunal aspirate. I think I am going to ask my dr, for it. I need to know for sure if it is sibo or not, and I believe there is plenty of justification to do it. Plus the article was written by Mayo drs so she can't argue that! Thank you so much, this is really helpful.

I do have symptoms of SIBO, I know I was tested years ago, but everything came back normal. I was told at the time I have irritable bowel syndrome, and I believe that may be the case, however the symptoms for me have coincided with postprandial pain. My pain is also relieved with sublingual nitro, so I am more persuaded by my symptoms being brought on by MALS or a vascular event. I have heard of other patients that deal with pancreatic insufficiency after having mals surgery. I really hope that more research can be done, and that patients would receive better follow up care. There really is no educational materials available for us, and long term support is left to us!

What is sublingual nitro? I'm thinking it sounds like a medication for the heart? So many things you have mentioned I haven't been told about as far as the MALS so thank you, this is helpful for me and many others I am sure.

@jmmb , yes Nitro is commonly used for chest pain like angina, it also works for intestinal angina. MALS constricts the arteries by compression of the ligament. Most people, once the ligament is released are symptom free, however some people's arteries have "memory" of the constriction and even after bypass can cause problems. In my case my arteries look open and flowing upon all tests, but I believe at times, mainly after I eat or exercise my arteries vasoconstrict so much that they go into spasm and cause pain. Nitro, a vasodilator opens the arteries up, and the pain goes away. Unfortunately your body can get use to nitro just like it can any medicine. I try and use it sparingly. Does that make sense?? What has worked best for me is Tramadol before meals, but doctors are not comfortable prescribing this medication because of its opioid effect. This makes it a challenge for me and my doctors. There is a combination of things that are contributing to MALS pain, another is the ganglion nerves... there is just not an easy fix.

Again, thank you. I have a CT angio this week so will be anxious to see results. Never know where my symptoms or pain is from anymore. Like I have said for 3 years was told SIBO, Mayo gi said no, but no answers, could be MALS, but hope not. But you have given me new information that I can ask educated questions about to my surgeon so that is helpful. thanks again.....

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linda

@kariulrich and anyone else I have another question. My MALS and "sibo" overlap. I am wondering if anyone else diagnosed MALS, has issues with the constipation for days, then frequency of bowel movement several times a day. A feast or famine as I call it. I definitely have the pain and bloating after eating, so that can be either. Curious about the bowels because this is a huge problem for me besides the pain.
Thanks....

@jmmb YES YES YES!!!!! I have the same problem, my MALS surgery helped with the pain but never the GI/bowel issues. Today is one of those days where I cannot leave the house... it is so severe. It takes up all my energy and I am left feeling so fatigued. The malabsorption issues have never improved for me. The one thing that has helped, but not cured these symptoms is gummy bear type fiber! I am with you about this being a huge problem.

Here is the fiber I use: https://www.amazon.com/dp/B00DKN8E0M

Well I am not crazy!!! (not that I wish this on anyone...)I can't figure this out. It totally sucks......I just did breath test for lactose, and it was positive. I knew this already for years. I'm afraid tomorrow at the GI follow up she is going to say that is where my symptoms come from, but NO, I didn't have these symptoms before surgery. Yes if I ate ice cream I would have an issue, but this is different. I'm sure it doesn't help, but this is not why. If I go tomorrow and she says its the lactose intolerance and irritable bowl I am going to loose my mind!!!! I will be back where I was 3 years ago with no answers. Sibo made sense, and with 3 positive tests I was hoping to get relief here. I know the MALS is related and will be lifetime. It is all related......I don't know why some doctors can't see that. Thanks for the fiber into. I use Miralax but not regularly because it depends on if its feast or famine time.....I will try yours.