Median Arcuate Ligament Syndrome (MALS)

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.....

@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.

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.

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!

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.

Thank you. It's nice to know you are not alone in all this. Did you have those sibo symptoms?

Hugs!

@jmmb All of my GI tests came back normal, like you my small intestine was a bit faster, and large intestine slow...they also told me this was normal, as far as your other tests etc...Mayo will sometimes have different parameters that they measure things by then what you find on the internet, ask them about it. Ask you Dr. Why they do not think you have SIBO, tell them what concerns you. The doctors are more than happy to explain, it is there area of interest and they want you there understand. Do not be afraid to tell them what you know, and why you think differently, that is part of advocating for yourself. Trust your self, you know what your body is telling you better than anyone. It will be interesting to see what the vascular doctor has to say. I know you have read a lot about SIBO, thought I would post this article as a reference for others. Keep us informed! http://www.mayoclinicproceedings.org/article/S0025-6196(16)30589-4/pdf

Thank you so much and I will keep everyone updated ! And please know our thoughts and prayers are with everyone as well.

Hi @kariulrich and everyone else. Well as you know from my posts, I have been going to Mayo in Scottsdale AZ. This was for GI issues. I recently met with a vascular surgeon and really liked him. I felt he was pretty educated. Before we go any further, he has me scheduled for CT angiogram with contrast to see how stents are doing. I mentioned the celiac block to him and he explained that, but wont know anything until scan.
My questions are if anyone has had any of the following happen to them and if so, what do you suggest. I was referred to Mayo GI due to SIBO. I have had 3 positive breath tests. First test was breath test with 50g of glucose and 2 hours. From most of my research that will only show top of small intestine. You need lactulose and at least 3 hours. My previous tests showed me peaking at about 2 hours and then way high. Also with glucose it is suppose to be 100g if used. My dr. says I absolutely don't have sibo. My gastric emptying tes showed faster than normal in the small intestine, and the very lowest number in the range of the other 2. It was 5 hours and come back next day. She said it was fine. My fructose breath test was negative but my lactose was positive with high numbers. I knew I had lactose intolerance before. I am afraid she will say this is why my symptoms and I don't beliee so since I have had that my whole life and all these symptoms now are just after the MALS 1st surgery. I also can't tell anymore which pain is from which problem. All previous gi drs said won't be able to get rid of sibo since arteries are narrowed and not enough blood flow. My previous surgeon said no it is fine. I am curious to see what the surgeon at Mayo in vascular says. For 3 years I have been researching sibo and now I am told I don't have it on a test I don't have much faith in. My gi dr. at Mayo said that one is better than the lactulose. I don't know what is wrong with me anymore I feel like.
Anyone else have this?