Median Arcuate Ligament Syndrome (MALS)

Median arcuate ligament syndrome (MALS) is a rare condition where a band of tissue under the diaphragm (the median arcuate ligament) presses on the celiac artery (a major artery that feeds the upper belly organs) and can also press on the nearby celiac nerve plexus (a nerve network). This pressure can reduce blood flow at certain times (often during breathing out) and can irritate nerves, which may lead to upper belly pain and other stomach-like symptoms. Many people can have celiac artery “compression” on scans but do not have symptoms, so doctors diagnose MALS only when symptoms fit and other common causes are ruled out. MDPI+3NCBI+3Mayo Clinic+3

Median arcuate ligament syndrome (MALS) is a rare condition where a tight band of tissue (the median arcuate ligament) presses on the celiac artery and often also presses on nearby nerves called the celiac plexus. This pressure can cause upper belly pain, especially after eating or exercise, plus nausea, vomiting, bloating, diarrhea, and weight loss in some people. Many people can have celiac artery “compression” on scans and still feel fine, so doctors usually diagnose MALS only after they rule out other common stomach problems and match the symptoms with imaging and clinical findings. Mayo Clinic+2PubMed Central+2

MALS pain is often described as pain in the upper middle belly (epigastric area), commonly worse after eating (post-prandial) or sometimes worse with exercise. People may eat less because they fear pain (“food fear”), and weight loss can happen over time. Because the symptoms can look like many other digestive problems, the work-up is usually long and includes blood tests and several imaging tests before doctors feel confident about the diagnosis. Cleveland Clinic+3RACGP+3Mayo Clinic+3

Another names

MALS is also called Dunbar syndrome, celiac artery compression syndrome, and celiac axis syndrome. Some doctors also use the name celiac artery compression syndrome (CACS) when they want to emphasize the artery narrowing, even though nerves may also play a role in symptoms. NCBI+2Mayo Clinic+2

Types

Commonly used “types” are:

1. Symptomatic MALS (true MALS),
2. Incidental/asymptomatic celiac artery compression,
3. Predominantly vascular (ischemia-leaning) MALS,
4. Predominantly neurogenic (nerve-leaning) MALS,
5. MALS with fixed celiac artery damage (fibrosis/stenosis), and
6. MALS with complications from long-term narrowing (rare, such as collateral-related aneurysm risk described in reviews). Cleveland Clinic+3NCBI+3RACGP+3

Symptomatic MALS (true MALS) means the person has the typical symptom pattern (often post-meal epigastric pain, nausea, weight loss) and testing supports clinically important compression. This is the group most likely to be discussed for MALS-specific care after other diagnoses are excluded. Cleveland Clinic+3NCBI+3RACGP+3

Incidental/asymptomatic celiac artery compression means scans show celiac artery compression, but the person has no matching symptoms. This is common enough that doctors must be careful not to label every compression finding as MALS. NCBI+2RACGP+2

Predominantly vascular (ischemia-leaning) MALS is used when the main problem seems to be low blood flow during higher demand (like after eating), causing foregut-related pain. Some articles discuss special tests (like tonometry in older research) to look for signs of poor stomach lining oxygen/acid changes in selected patients. ochsnerjournal.org+3RACGP+3NCBI+3

Predominantly neurogenic (nerve-leaning) MALS is used when nerve irritation and nerve-driven vessel spasm (vasoconstriction) seem to explain symptoms better than blood-flow limits alone. In these cases, temporary pain relief after a celiac plexus block may support a neurogenic component in the right clinical setting. Dove Medical Press+3NCBI+3RACGP+3

MALS with fixed celiac artery damage (fibrosis/stenosis) means long-term repeated compression has led to changes in the artery wall (fibrotic/intimal-type changes described in summaries), so the narrowing may become more “fixed,” not only positional. This can matter because some people may still have narrowing even after ligament release. NCBI+2RACGP+2

MALS with complications from long-term narrowing is uncommon, but long-standing severe narrowing can be linked (in clinical discussions and reviews) to downstream vessel changes, including collateral flow patterns and, in rare situations, aneurysm concerns in collateral vessels. This is not the “usual” presentation, but it explains why doctors take the condition seriously when severe and persistent. RACGP+1

Causes

1) Low insertion of the median arcuate ligament (diaphragm band sits too low). If the ligament attaches lower than usual, it can cross directly over the celiac artery origin and press on it, especially when breathing out. This is one of the main anatomical reasons described for MALS. NCBI+2RACGP+2

2) High (cephalad) origin of the celiac artery (celiac artery starts higher than usual). If the celiac artery begins a little higher on the aorta than normal, it may sit closer to the ligament and be more likely to be compressed by it. NCBI+1

3) Congenital (born-with) anatomy differences. Some people may be born with diaphragm/artery positions that make compression more likely. Family and twin observations have been discussed in medical summaries, which supports the idea that anatomy can be partly congenital. NCBI+1

4) Breathing mechanics that increase compression during expiration. During breathing out (expiration), the diaphragm moves upward and the crura can tighten, which can increase pressure on the celiac artery in people with susceptible anatomy. This is why MALS is often described as “worse with deep expiration.” NCBI+2McGovern Medical School+2

5) External compression of the celiac plexus (nerve network) along with the artery. Symptoms may come not only from blood flow changes but also from pressure on the nerve plexus around the artery. Nerve irritation can create pain signals and can also affect vessel tone. RACGP+2NCBI+2

6) Nerve-driven abnormal vessel narrowing (vasoconstriction). Some explanations say the compressed/irritated celiac plexus can “over-stimulate” nerves, leading to spasm-like narrowing of small vessels (vasoconstriction). This can add pain even if major artery flow is not fully blocked. NCBI+2RACGP+2

7) Ischemia during higher demand after meals. After eating, the stomach and upper gut need more blood for digestion. If celiac flow is restricted at that time, pain can happen, which is one reason post-meal pain is so common in MALS descriptions. RACGP+2MDPI+2

8) “Steal” phenomenon through collateral vessels (a theory). Some papers discuss a theory that blood may be diverted through collateral routes in a way that leaves other bowel areas short of blood after meals, contributing to pain. This is a proposed mechanism, not a single proven cause in every patient. RACGP+1

9) Long-term repeated compression causing artery wall thickening changes. Over time, repeated pressure can lead to structural changes in the celiac artery wall (described as fibrotic-type changes in summaries). These changes can make narrowing more persistent. NCBI+1

10) Progression to significant stenosis or even occlusion (in severe cases). If narrowing becomes severe and long-standing, it may progress toward near-blockage in some people, which can increase symptoms and can complicate management. RACGP+2NCBI+2

11) Post-stenotic dilation (widening after a tight narrowed point). A tight narrowing can change flow patterns so the vessel segment after the narrowing may widen (dilate). This is a flow effect described in clinical discussions of long-term compression. RACGP+1

12) Collateral circulation changes that become “overworked.” Because the body can reroute blood through other arteries, collateral pathways can enlarge. In some scenarios, these altered pathways may be linked to symptoms or rare vessel complications described in reviews and clinical pathways. RACGP+1

13) Celiac ganglion entrapment (nerve bundle involvement). Some explanations focus on the idea that the celiac ganglion/plexus is trapped or irritated, which can change stomach function and pain signaling, even beyond pure blood flow issues. RACGP+2MDPI+2

14) Altered stomach electrical activity and motility (a proposed effect). Neurogenic theories include that nerve irritation can alter gastric myoelectrical activity and stomach movement, which may help explain nausea, early fullness, and bloating in some patients. RACGP+1

15) Body habitus and “slim” appearance seen in many patients (association, not blame). Many described patients are slim, and weight loss can also result from food fear and reduced intake. This does not mean slimness causes MALS, but it often appears together in clinical descriptions. RACGP+2Cleveland Clinic+2

16) Exercise-related demand triggering symptoms. Exercise can increase blood-flow needs and can also trigger pain in some people with MALS, so pain after activity is commonly described alongside post-meal pain. RACGP+2Cleveland Clinic+2

17) Abnormal position after prior surgery or trauma (possible contributor in some cases). Some clinicians and patient resources note that MALS-like symptoms may be seen after abdominal/spinal surgery or trauma in certain cases, possibly by changing anatomy or scarring patterns, though this is not the main cause for most people. Cleveland Clinic+2MDPI+2

18) Diagnostic delay leading to chronic pain cycle (worsening experience). Many people have symptoms for a long time before diagnosis, and chronic pain can increase stress and sensitivity. This does not “cause” the compression, but it can amplify how severe symptoms feel day to day. Cleveland Clinic+2Mayo Clinic+2

19) Co-existing autonomic problems (example: POTS mentioned in assessment discussions). Some clinical discussions advise checking for autonomic symptoms (like POTS) because they can coexist and may influence dizziness, fatigue, and symptom burden. This is not a direct cause of MALS, but it can be a contributing “why this person feels so unwell.” RACGP+1

20) “Compression on imaging but symptoms only in a small minority.” A key reason for confusion is that many people have radiologic compression, but only a small portion have true symptom-producing MALS. So the “cause” of symptoms is likely a mix of anatomy + nerve effects + individual sensitivity, not compression alone. NCBI+2RACGP+2

Symptoms

1) Upper middle belly pain after eating (post-prandial epigastric pain). This is the classic symptom. Pain often starts after meals because digestion increases blood-flow demand and can also trigger nerve irritation in the compressed area. Cleveland Clinic+2RACGP+2

2) Pain that worsens with exercise. Some people feel pain during or after physical activity. Exercise can raise the body’s need for blood flow and may bring out symptoms in susceptible anatomy. RACGP+2MDPI+2

3) Nausea. Nausea is common and may happen with pain episodes, especially after meals. It can be linked to stress response, altered stomach movement, or nerve irritation near the celiac plexus. Cleveland Clinic+2RACGP+2

4) Vomiting. Vomiting can occur during severe episodes, often after eating. This symptom is not specific to MALS, which is why doctors check many other causes before diagnosing MALS. Cleveland Clinic+2Mayo Clinic+2

5) Bloating (feeling swollen or full). Many patients describe bloating. It may be related to changes in stomach function and gut movement, or simply to eating less regularly and having irregular digestion. Cleveland Clinic+1

6) Early fullness (getting full quickly). Some people feel full after small amounts of food. This can happen when pain and nausea discourage normal eating, and when stomach function is affected by nerve-related mechanisms discussed in reviews. RACGP+2MDPI+2

7) “Food fear” (avoiding eating because it triggers pain). People may avoid meals because they learned that eating causes pain. This pattern is often mentioned in clinical descriptions and can strongly affect nutrition and daily life. RACGP+2Cleveland Clinic+2

8) Weight loss (often unplanned). Weight loss can happen because people eat less to avoid pain, or because nausea and vomiting reduce intake. Tracking weight over time is part of clinical assessment. NCBI+2Cleveland Clinic+2

9) Diarrhea. Some people report diarrhea, especially around symptom flares. This symptom is also common in many other gut problems, so it mainly helps describe the overall pattern rather than confirming MALS. Cleveland Clinic+2NCBI+2

10) Constipation. Some patients report constipation instead of diarrhea. Irregular gut movement can be part of a broader functional pattern, and it is one reason doctors must rule out other digestive diseases. RACGP+2Mayo Clinic+2

11) Epigastric tenderness (mild pain when pressed). On exam, some people have mild tenderness in the upper belly. Others may have a fairly normal belly exam, so tenderness is helpful when present but not required. NCBI+2RACGP+2

12) Abdominal bruit (whooshing sound). A clinician may hear a whooshing sound (bruit) in the upper belly, sometimes louder with expiration. A bruit can happen when an artery is narrowed. Mayo Clinic+2NCBI+2

13) Fatigue (feeling tired). Long-lasting pain, reduced food intake, poor sleep, and stress can produce fatigue. This symptom does not prove MALS, but it often appears when symptoms continue for months or years. Cleveland Clinic+2Mayo Clinic+2

14) Anxiety or low mood related to chronic symptoms. Living with hard-to-explain pain and repeated tests can affect mental health, and depression/anxiety are noted as concerns in patient experiences and clinical discussion. This is an effect of the illness experience, not “the cause.” Cleveland Clinic+2Mayo Clinic+2

15) Symptoms that come and go (episodic pattern). Symptoms may flare after meals or activity and then settle, which fits the idea that compression and demand change across time (breathing, eating, exertion). Episodic symptoms are one reason diagnosis can be delayed. Mayo Clinic+2RACGP+2

Diagnostic tests

MALS has no single “one test” that proves it. Doctors usually combine: (1) your symptom story, (2) physical findings, (3) tests to rule out more common causes, and (4) imaging that shows celiac artery compression that changes with breathing. MDPI+3Mayo Clinic+3NCBI+3

Physical Exam (tests done by looking, feeling, and listening)

1) Symptom-focused medical history (meal and exercise link). The clinician asks when pain happens, how it relates to meals, and whether exercise triggers it. This “pattern” matters because MALS commonly causes post-meal and exercise-related epigastric pain. RACGP+2Mayo Clinic+2

2) Weight and nutrition trend check. The clinician checks your current weight and compares it with older weights if possible. Weight loss over time supports the typical MALS story (often from eating less due to pain). NCBI+2Cleveland Clinic+2

3) Abdominal palpation (pressing on the upper belly). The clinician presses the epigastric area to see if there is tenderness or guarding. Many people have only mild tenderness, and some have a normal exam, so this test helps but does not decide alone. NCBI+2RACGP+2

4) Abdominal auscultation for a bruit. The clinician listens with a stethoscope for a whooshing sound (bruit) that can happen when a vessel is narrowed. A bruit is not always present, but it is a helpful clue when found. Mayo Clinic+2NCBI+2

Manual tests (bedside maneuvers and simple in-clinic checks)

5) Expiration vs inspiration bruit check (respiratory maneuver). The clinician may listen while you breathe in and out deeply, because MALS compression is often worse during deep expiration. A bruit that becomes clearer with expiration can support suspicion. NCBI+2RACGP+2

6) Meal-trigger diary (structured symptom recording). You record what you eat, when pain starts, and how long it lasts for several days. This is not a “machine test,” but it is a practical bedside tool to show a consistent post-meal pattern that fits MALS descriptions. Mayo Clinic+2RACGP+2

7) Orthostatic vital signs when autonomic symptoms exist. If you also have dizziness, racing heart on standing, or other autonomic symptoms, the clinician may check pulse and blood pressure lying/standing. This helps identify co-existing autonomic problems that can worsen overall symptoms. RACGP+1

Lab and Pathological tests (blood tests and “rule-out” procedures) NCBI+2Mayo Clinic+2

8) Complete blood count (CBC). A CBC checks red cells, white cells, and platelets. Doctors use it to look for infection, anemia, or inflammation clues that could explain pain and weight loss in another way. Mayo Clinic+2NCBI+2

9) Liver function tests (hepatic function testing). These blood tests help rule out liver or bile-related disease that can cause upper belly pain, nausea, or abnormal digestion. They do not diagnose MALS, but they reduce uncertainty. NCBI+2RACGP+2

10) Serum amylase. Amylase can rise with some pancreas problems. Because pancreas disease can also cause upper abdominal pain and vomiting, doctors may check this during evaluation. NCBI+1

11) Serum lipase. Lipase is another pancreas-related blood test, often more useful than amylase for pancreatitis. It is part of common “rule-out” testing when the symptoms could fit pancreas problems. NCBI+2RACGP+2

12) C-reactive protein (CRP). CRP is a general inflammation marker. Doctors may use it to look for inflammatory bowel disease, infection, or other inflammatory causes of pain, because MALS itself is not usually diagnosed by inflammation markers. NCBI+2RACGP+2

13) Autoimmune antibody testing (example: anti-smooth muscle antibody, ASMA). In some workups, certain antibodies are checked to rule out autoimmune liver or systemic disease that could contribute to symptoms or abnormal liver tests. This supports the “diagnosis of exclusion” approach. NCBI+1

14) Upper endoscopy (EGD), sometimes with biopsy. An endoscopy looks inside the esophagus, stomach, and first part of the small intestine. Doctors use it to rule out ulcers, inflammation, and other common causes of post-meal pain and nausea before labeling MALS. Mayo Clinic+2NCBI+2

15) Colonoscopy (when symptoms suggest lower-gut causes). Colonoscopy may be used to rule out colon disease, especially when diarrhea, bleeding, or other red flags exist. It helps confirm that symptoms are not better explained by another diagnosis. NCBI+1

Electrodiagnostic / physiologic tests (special tests, used in selected cases)

16) Celiac plexus block (diagnostic nerve block). In suspected neurogenic MALS, a specialist may inject anesthetic near the celiac plexus using imaging guidance. If pain improves for a short time, it can support a nerve-driven component and may help predict who benefits from decompression surgery. PubMed+2Dove Medical Press+2

17) Gastric tonometry (older/limited-availability physiologic test). Some research describes gastric tonometry to look for signs of stomach lining ischemia (low oxygen/flow effect) during symptoms and improvement after release. It is not used everywhere, but it shows how doctors have tried to measure “real ischemia” in selected patients. ScienceDirect+2ochsnerjournal.org+2

Imaging tests (tests that can show compression and blood flow changes)

18) Duplex Doppler ultrasound of the celiac artery (with breathing in and out). This is a key noninvasive test. It measures blood-flow speed in the celiac artery and can show worse narrowing during deep expiration. Criteria often cited include an expiratory peak systolic velocity above about 200 cm/s and a deflection angle above about 50 degrees as supportive findings. NCBI+2Mayo Clinic+2

19) CT angiography (CTA). CTA can show the celiac artery shape and narrowing and can also help rule out other causes (like atherosclerosis or masses) while showing the typical “hooked” narrowing pattern described in imaging discussions. It is commonly used in the MALS work-up. RACGP+3NCBI+3MDPI+3

20) MR angiography (MRA). MRA is another way to view the celiac artery and surrounding anatomy without the same type of radiation as CT. It can help confirm the narrowing pattern and support the diagnosis when combined with symptoms and other negative tests. RACGP+3NCBI+3MDPI+3

21) Conventional catheter angiography (digital subtraction angiography / visceral angiography). This invasive test injects contrast directly and can show detailed vessel narrowing and flow, sometimes including dynamic changes. It is often reserved for complex cases or when planning certain treatments. NCBI+2RACGP+2

Non-pharmacological treatments (therapies + other supportive care)

1. Small, frequent meals: Eat 5–6 small meals instead of 2–3 large meals to reduce “after-meal” pain load. Purpose: less stomach/nerve trigger. Mechanism: smaller meals may reduce post-meal stress and symptom flares reported in MALS patterns. Mayo Clinic

2. Avoid heavy exercise right after eating: Purpose: prevent post-exercise belly pain. Mechanism: MALS pain often appears after meals or exercise; spacing activity away from meals may reduce symptom triggers. Mayo Clinic

3. Food-symptom diary: Purpose: find personal triggers (fatty foods, big portions, carbonated drinks, etc.). Mechanism: helps identify patterns and supports a structured plan with your clinician and dietitian. Mayo Clinic

4. Lean-forward posture during symptoms: Some people feel better leaning forward. Purpose: short-term pain relief. Mechanism: posture may change tension around the compressed area and reduce nerve irritation in some patients. Mayo Clinic

5. Dietitian-guided nutrition plan: Purpose: prevent weight loss and nutrient deficiency. Mechanism: planned calories/protein, gentle foods, and symptom-aware meal timing can protect growth and energy (very important for teens). Mayo Clinic

6. Oral rehydration during vomiting/diarrhea: Purpose: prevent dehydration. Mechanism: oral rehydration salts (ORS) replace water + electrolytes effectively. World Health Organization+1

7. Psychological support (CBT, coping skills): Purpose: reduce fear of eating, anxiety, and pain stress. Mechanism: chronic pain and food-fear can worsen quality of life; structured therapy improves coping and daily function. Mayo Clinic

8. Pain clinic evaluation (multidisciplinary): Purpose: safer pain plan and less “trial-and-error.” Mechanism: combines non-drug tools, targeted procedures, and careful medication choices if needed. NCBI

9. Celiac plexus block (diagnostic + sometimes therapeutic): Purpose: test if pain is nerve-driven and may predict benefit from release surgery. Mechanism: numbs the celiac plexus pain pathway; studies suggest prognostic value before surgery in selected patients. PubMed+1

10. Gentle walking, not intense workouts: Purpose: keep fitness without triggering pain. Mechanism: symptom-aware movement avoids the “exercise pain” pattern described in MALS. Mayo Clinic

11. Sleep routine (same bedtime/wake time): Purpose: lower pain sensitivity and stress. Mechanism: poor sleep can increase pain intensity in many chronic pain conditions, so sleep hygiene supports recovery. Mayo Clinic

12. Heat therapy (warm pack on upper abdomen): Purpose: comfort during flares. Mechanism: heat can relax muscles and reduce pain perception (supportive, not curative). Mayo Clinic

13. Avoid tight belts/waist compression: Purpose: reduce belly pressure discomfort. Mechanism: external pressure can worsen sensation and nausea in sensitive upper-abdominal pain states. Mayo Clinic

14. Treat constipation early (diet fiber carefully + hydration): Purpose: reduce bloating and pain overlap. Mechanism: constipation can amplify abdominal discomfort; careful bowel routine reduces extra triggers. Mayo Clinic

15. Rule-out testing plan (diagnosis of exclusion): Purpose: avoid missing other diseases (ulcer, gallbladder, pancreatitis, IBD, etc.). Mechanism: MALS symptoms overlap many conditions; structured work-up is standard. Mayo Clinic+1

16. Imaging with experienced vascular/GI teams: Purpose: accurate diagnosis. Mechanism: duplex ultrasound and CTA/MRA patterns (often dynamic with breathing) help support MALS when matched to symptoms. Medultrason+1

17. Avoid smoking (and secondhand smoke): Purpose: better vessel health and healing. Mechanism: smoking worsens vascular health and surgical recovery risk in general. PubMed Central

18. Pre-surgery “prehab” (nutrition + light conditioning): Purpose: better surgical recovery. Mechanism: stronger nutrition status is linked to improved healing and fewer complications in many surgeries. PubMed Central

19. Post-surgery rehab plan: Purpose: reduce relapse of deconditioning and support return to school/sports safely. Mechanism: gradual activity progression after ligament release is commonly used in surgical pathways. ScienceDirect+1

20. Seek MALS-experienced surgeons: Purpose: improve selection and technique. Mechanism: outcomes vary; studies comparing approaches show different risk/benefit profiles, so expert evaluation matters. ScienceDirect+2PubMed Central+2

Drug treatments

Safety note (very important for teens): dosing depends on age, weight, diagnosis, and other medicines. Do not self-start these. Use them only with a licensed clinician. Mayo Clinic

1. Omeprazole (PPI): lowers stomach acid for reflux-type symptoms that can overlap with MALS discomfort. Purpose: less burning/nausea. Mechanism: blocks acid pumps in stomach lining. Side effects: headache, diarrhea, low magnesium/B12 risk with long use. FDA Access Data

2. Pantoprazole (PPI): similar role to omeprazole when acid irritation worsens symptoms. Mechanism: acid pump inhibition. Side effects: stomach upset, headache, long-term nutrient issues in some users. FDA Access Data

3. Famotidine (H2 blocker): another acid-reducing option. Purpose: reduce reflux/upper-stomach irritation. Mechanism: blocks histamine-2 receptors in stomach. Side effects: headache, constipation/diarrhea. FDA Access Data

4. Sucralfate: coats and protects irritated stomach/duodenum lining (useful if gastritis/ulcer-like irritation is present alongside MALS workup). Mechanism: protective barrier on mucosa. Side effects: constipation. FDA Access Data

5. Ondansetron: anti-nausea medicine. Purpose: reduce nausea/vomiting so you can hydrate and eat. Mechanism: blocks 5-HT3 serotonin receptors. Side effects: constipation, headache; rhythm risk in some patients. FDA Access Data

6. Promethazine: anti-nausea with sedation. Purpose: nausea control (sometimes when other meds fail). Mechanism: antihistamine effects plus central antiemetic action. Side effects: strong sleepiness, breathing risk in some groups—must be clinician-directed. FDA Access Data+1

7. Metoclopramide: for nausea related to slow stomach emptying (only when a clinician confirms it’s appropriate). Mechanism: dopamine effects that increase gut movement. Side effects: movement disorders/twitching risk with longer use; must be carefully monitored. FDA Access Data

8. Dicyclomine: antispasmodic sometimes used for cramping-type abdominal pain overlap. Mechanism: anticholinergic smooth-muscle relaxation. Side effects: dry mouth, dizziness, constipation; not for everyone. FDA Access Data+1

9. Acetaminophen (paracetamol): basic pain reliever that can be safer for the stomach than NSAIDs. Mechanism: central pain pathways. Side effects: liver injury if overdosed; avoid combining multiple acetaminophen products. FDA Access Data

10. Ibuprofen (NSAID): may help pain but can irritate stomach and increase bleeding risk in some people. Mechanism: COX inhibition (less prostaglandins). Side effects: stomach bleeding risk, kidney risk (especially dehydration). FDA Access Data+1

11. Naproxen (NSAID): longer-acting NSAID option (clinician-guided only). Side effects: stomach bleeding risk, kidney risk; avoid if dehydrated or with ulcer history. FDA Access Data+1

12. Tramadol: opioid-like pain medicine sometimes used for severe pain under close medical control. Major teen warning: can cause dangerous breathing problems and dependence; avoid unless a specialist prescribes and monitors. FDA Access Data+1

13. Gabapentin: sometimes used for nerve-type pain features. Mechanism: reduces nerve signaling in pain pathways. Side effects: sleepiness, dizziness; tapering is often needed. FDA Access Data

14. Amitriptyline (low-dose TCA in pain practice): sometimes used for chronic pain modulation and sleep. Mechanism: changes serotonin/norepinephrine signaling. Side effects: dry mouth, constipation, sleepiness; cardiac caution in some patients. FDA Access Data

15. Duloxetine (SNRI): used for chronic pain conditions and anxiety/depression overlap. Mechanism: serotonin/norepinephrine reuptake inhibition. Side effects: nausea, sleep changes; tapering needed. FDA Access Data+1

16. Sertraline (SSRI): may help anxiety/depression that can worsen food fear and pain coping. Mechanism: serotonin reuptake inhibition. Side effects: nausea, sleep issues; monitor mood changes in teens. FDA Access Data

17. Buspirone: non-sedating anxiety medicine used in some patients. Mechanism: serotonin-1A activity. Side effects: dizziness, nausea; needs scheduled use, not “as needed” in many cases. FDA Access Data

18. Loperamide: for short-term diarrhea control (only if clinician says diarrhea is not from infection). Mechanism: slows bowel movement via opioid receptors in gut. Side effects: constipation; overdose can be dangerous. FDA Access Data+1

19. Polyethylene glycol 3350: for constipation (common when eating less or using certain nausea/pain meds). Mechanism: draws water into stool. Side effects: bloating/diarrhea if too much; teens should use with medical guidance. FDA Access Data+1

20. Simethicone: for gas/bloating discomfort. Mechanism: breaks up gas bubbles. Side effects: usually mild; effectiveness varies. FDA Access Data

Dietary molecular supplements

These can help specific symptoms (like nausea or diarrhea dehydration). Supplement quality differs, and teens should use them only with a clinician/dietitian. Mayo Clinic

1. Oral Rehydration Salts (ORS): helps dehydration from vomiting/diarrhea. Function: replaces electrolytes and fluid. Mechanism: glucose-salt transport pulls water back into the body. World Health Organization+1

2. Ginger (food or supplement): may reduce nausea for some people, though results vary by study and situation. Mechanism: may affect stomach emptying and nausea signaling. Caution: can cause heartburn in some. PubMed+1

3. Peppermint oil (enteric-coated): used for crampy/IBS-type symptoms that can overlap during workup. Mechanism: antispasmodic effects on gut smooth muscle. Caution: reflux can worsen in some. BMJ+1

4. Probiotics (specific strains): may help some functional GI symptoms or diarrhea patterns, but effects depend on strain and condition. Mechanism: changes gut microbiome and inflammation signaling. AAFP+1

5. Zinc (short course in diarrhea, clinician-guided): used in some diarrhea care approaches. Mechanism: supports gut lining repair and immune response. Caution: excess causes nausea and copper issues. World Health Organization

6. Vitamin D (if deficient): deficiency is common and can worsen fatigue and health. Mechanism: hormone-like vitamin affecting bone, muscle, immune regulation. Use: best when labs confirm deficiency. Mayo Clinic

7. Vitamin B12 (if low, especially with long PPI use): may support energy and nerves if deficient. Mechanism: needed for blood and nerve function. FDA Access Data

8. Magnesium (only if low or constipated, clinician-guided): can help constipation or cramps in some people. Mechanism: electrolyte for muscles and nerves; some forms soften stool. Caution: diarrhea with excess. Mayo Clinic

9. Omega-3 (food-based first): supports general health; evidence is not specific to MALS. Mechanism: affects inflammatory signaling. Caution: high doses can increase bleeding risk in some contexts. PubMed Central

10. Protein/calorie supplements (medical nutrition shakes): helps weight loss and low intake. Mechanism: concentrated nutrition with easier digestion for some people. Goal: prevent malnutrition while diagnosis/treatment proceeds. Mayo Clinic

Immunity booster / regenerative / stem cell drugs

For MALS specifically, there are no FDA-approved “regenerative,” “stem cell,” or “immunity booster” drugs that treat the cause. Be very careful: many clinics advertise unapproved regenerative products for many illnesses, and the FDA has warned consumers about risks and misleading marketing. If someone offers stem cells/exosomes to “cure” MALS, treat it as a red flag unless it is a legitimate, registered clinical trial discussed by your surgical team. U.S. Food and Drug Administration+2U.S. Food and Drug Administration+2

Surgeries/procedures

1. Median arcuate ligament release (MALR): the surgeon cuts the tight ligament to remove pressure. Why: targets the main compression problem. Can be open or minimally invasive. Mayo Clinic+1

2. Laparoscopic MALR: small cuts + camera tools. Why: often shorter hospital stay and fewer complications than open in many series, but outcomes depend on anatomy and surgeon experience. ScienceDirect+1

3. Robotic-assisted MALR: robotic tools can help fine dissection. Why: may improve precision in some centers; still depends on expertise. ejvesvascularforum.com+1

4. Celiac ganglionectomy / celiac plexus neurolysis (done with release in some cases): removes or disrupts painful nerve tissue near the artery. Why: many symptoms are thought to be nerve-driven, not only blood-flow-driven. Mayo Clinic+1

5. Revascularization (artery repair) or selected endovascular procedures: patch, bypass, or sometimes angioplasty/stent in carefully chosen cases (often considered after decompression if narrowing remains). Why: restore/maintain flow if the artery stays severely narrowed. PubMed Central+1

Prevention steps

You usually cannot prevent the anatomic setup that leads to MALS, but you can reduce complications and avoid worsening. Mayo Clinic

1. Prevent dehydration during vomiting/diarrhea (use ORS early). World Health Organization+1

2. Prevent weight loss with early dietitian support and calorie planning. Mayo Clinic

3. Prevent constipation (hydration + stool routine if needed). FDA Access Data

4. Prevent NSAID stomach injury (avoid frequent NSAIDs unless your clinician approves). FDA Access Data+1

5. Prevent unsafe opioid exposure (avoid tramadol/opioids unless a specialist prescribes). FDA Access Data

6. Prevent delayed diagnosis (seek evaluation if pain is persistent and meal-related). Mayo Clinic

7. Prevent trigger stacking (don’t combine large meals + immediate intense exercise). Mayo Clinic

8. Prevent supplement/medicine interactions (tell your doctor everything you take). U.S. Food and Drug Administration

9. Prevent stress-pain amplification with coping therapy and sleep routine. Mayo Clinic

10. Prevent “scam treatments” (avoid unapproved regenerative/stem cell products). U.S. Food and Drug Administration+1

When to see a doctor

See a doctor soon if you have repeated upper abdominal pain after eating, ongoing nausea/vomiting, or unplanned weight loss, because MALS symptoms overlap many serious conditions and need a real work-up. Get urgent care if there is severe pain with blood in stool, fever, nonstop vomiting, belly swelling, or signs of dehydration. Mayo Clinic

What to eat and what to avoid

These are symptom-support ideas while you’re being evaluated; personalize with a dietitian. Mayo Clinic

1. Eat: small meals; avoid: huge meals. Mayo Clinic

2. Eat: soft, easy foods (rice, oats, soup); avoid: very greasy fried foods if they trigger nausea. Mayo Clinic

3. Eat: lean protein; avoid: heavy fatty meats if pain flares after eating. Mayo Clinic

4. Eat: bananas/toast/yogurt if tolerated; avoid: foods that clearly trigger bloating. Mayo Clinic

5. Drink: water/ORS; avoid: dehydration (especially if vomiting). World Health Organization+1

6. Eat: cooked vegetables; avoid: very spicy foods if they worsen reflux. Mayo Clinic

7. Drink: non-carbonated fluids; avoid: carbonated drinks if bloating is severe. Mayo Clinic

8. Eat: slow, calm meals; avoid: rushing meals + immediate exercise. Mayo Clinic

9. Eat: calorie-dense but gentle foods (nut butter if tolerated); avoid: long fasting that worsens weakness/weight loss. Mayo Clinic

10. Eat: individualized plan; avoid: strict elimination diets without medical supervision (risk of malnutrition in teens). Mayo Clinic

FAQs

1. Is MALS the same as “celiac artery compression”? Not always—compression on scans can exist without symptoms; MALS means compression plus a matching symptom pattern. Mayo Clinic+1

2. What causes the pain? Many experts think nerve compression (celiac plexus irritation) is a major driver, not only reduced blood flow. Mayo Clinic+1

3. What are the classic symptoms? Upper belly pain after eating or exercise, nausea/vomiting, weight loss, bloating, diarrhea—varies by person. Mayo Clinic

4. Why does leaning forward sometimes help? Posture may change tension around the compressed area and reduce symptoms for some people. Mayo Clinic

5. How is it diagnosed? Usually by symptoms + exclusion of other diseases + supportive imaging (duplex ultrasound, CTA/MRA), sometimes with a celiac plexus block. PubMed Central+2Medultrason+2

6. Is a celiac plexus block only for cancer pain? It’s common in cancer pain, but it can also be used in selected benign conditions and as a diagnostic/prognostic tool. NCBI+1

7. Can medicines cure MALS? No—medicines mainly reduce symptoms; surgery targets the cause. Mayo Clinic+1

8. Does surgery always work? Many people improve, but not everyone; outcomes depend on selection, technique, and other overlapping conditions. ScienceDirect+1

9. Open vs laparoscopic—what’s the difference? Laparoscopic often has faster recovery; some studies show open may have stronger symptom improvement in certain outcomes but with higher morbidity—your surgeon decides based on your case. ScienceDirect

10. Can teens get MALS? Yes, it can occur even in children/teens, though it’s uncommon. Mayo Clinic+1

11. What should I do during a pain flare? Stop, rest, sip fluids/ORS, use clinician-approved nausea/pain steps, and seek help if severe or dehydrated. Mayo Clinic+1

12. Is weight loss dangerous? Yes—especially for teens. Early nutrition support is important. Mayo Clinic

13. Do supplements fix MALS? No. Some may help nausea or bowel symptoms, but they do not remove the compression. Mayo Clinic+1

14. Are stem cell/regenerative injections recommended? Not for MALS; FDA has warned consumers about unapproved regenerative products and misleading claims. U.S. Food and Drug Administration+1

15. What specialist should I see? Start with a clinician for evaluation (often GI), and if MALS is suspected/confirmed, a vascular or specialized surgeon/team experienced in MALS. Mayo Clinic+1

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: December 16, 2025.