Superior mesenteric artery syndrome – diagnostic difficulties

Background
Superior mesenteric artery syndrome (SMAS) is a rare disease caused by the acute angle of branching of the superior mesenteric artery from the aorta.

Material and methods
There were 63 patients (56 women and 7 men) with low body weight, who reported recurrent persistent abdominal pain, nausea, post-prandial vomiting, significant weight loss. All of them had abdominal ultrasonography performed with measurement of the angle of branching of SMA from the aorta. CBC, total bilirubin, AST, ALT, GT, ALP, amylase, lipase, albumins, iron, sodium, potassium, GFR, lipid profile, TSH, urinalysis were ordered. Additionally, esophagogastroduodenoscopy with Hp. test and esophageal impedance measurement in correlation with the reported ailments was performed.

Results
Acid reflux impedance was diagnosed in 10 patients. There were >55 acid reflux episodes per day and a positive reflux sign (SI) for heartburn and nausea. Abnormal impedance recording of acid reflux was diagnosed in 17 patients. They had >21 episodes of non-acid reflux per day. Positive reflux sign (SI) was not confirmed for any non-acid reflux-related symptoms.

Conclusions
It is justified to perform impedance pH monitoring in this group of patients as it allows to modify the therapy. The most important dietary recommendations are weight gain and understanding the cause of the disease.