kangaSue
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A couple of things turned up in researching the links between gastroparesis, Superior Mesentery Artery Syndrome (SMAS) and Nutcracker Syndrome (a.ka, Nutcracker Phenomenon or Pelvic Congestion Syndrome) that will likely be of interest for some with Chronic Fatigue Syndrome.
Gastroparesis is something that can occur as a result of having SMAS. SMAS can result as a consequence of having Nutcracker Syndrome (NCS) as both of these can have the same cause of onset, loss of the retroperitoneal fat pad between the aorta and the superior mesentery artery causing compression of both the duodenum and left renal vein. Compression of the left renal vein can disrupt the outflow of blood from the kidney into the inferior vena cava which can then instead reflux into the left ovarian vein which will be visible in an abdominal CT scan, often because the ovarian vein is grossly enlarged. It affects mostly women but guys can get this and have problems in the left testicle.
I've been diagnosed with Gastroparesis and Nutcracker Syndrome, SMAS is still in debate but it fits for my clinical picture (I don't identify with having ME/CFS though). I don't get chronic fatigue and only have mild Orthostatic Hypotension but it was interesting to find that, as well as there being known atypical presentation of NCS (including no compression of the left renal, no blood and/or protein in the urine, being totally asymptomatic), a number of papers mentioned that severe POTS or OH is a symptom that some people also have with NCS, along with chronic fatigue too.
I can't find any statistics on the frequency of this but in reading about NCS in various forums, anecdotal evidence does indicate POTS to be a known co-morbidity in some people. A post by someone in one forum who also had severe POTS said that their Neurologist had mentioned to them that they had encountered several other patients with both POTS and NCS at their clinic.
The other aspect that cropped up in looking into this is that some papers suggest paediatric Chronic Fatigue Syndrome can also be related back to having NCS in also having symptoms of having orthostatic hypotension, postural tachycardia, or other autonomic dysfunction symptoms and chronic fatigue. Most of the papers are fairly dated now so again, not a lot of statistics are around on the subject.
Some children just grow out of this so it begs the question, does that maybe leave them open to developing this again later in life?
Patients' age for NCS can range from childhood to the seventh decade of life, but most symptomatic patients are in their second or third decade of life, it's more commonly reported in women and there's looking to be a second peak of NCS in middle-aged women, a somewhat similar pattern to ME/CFS too.
Because NCS itself can be totally asymptomatic, it is something to keep in mind with having POTS or issues of gastrointestinal disturbances and/or unexplained abdominal/pelvic pain.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2878259/ Nutcracker Phenomenon and Nutcracker Syndrome
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5101106/ Unusual Manifestation of Superior Mesenteric Artery Syndrome in a Female Patient: A Case Presentation
https://www.ncbi.nlm.nih.gov/pubmed/10749295 Does severe nutcracker phenomenon cause pediatric chronic fatigue?
Gastroparesis is something that can occur as a result of having SMAS. SMAS can result as a consequence of having Nutcracker Syndrome (NCS) as both of these can have the same cause of onset, loss of the retroperitoneal fat pad between the aorta and the superior mesentery artery causing compression of both the duodenum and left renal vein. Compression of the left renal vein can disrupt the outflow of blood from the kidney into the inferior vena cava which can then instead reflux into the left ovarian vein which will be visible in an abdominal CT scan, often because the ovarian vein is grossly enlarged. It affects mostly women but guys can get this and have problems in the left testicle.
I've been diagnosed with Gastroparesis and Nutcracker Syndrome, SMAS is still in debate but it fits for my clinical picture (I don't identify with having ME/CFS though). I don't get chronic fatigue and only have mild Orthostatic Hypotension but it was interesting to find that, as well as there being known atypical presentation of NCS (including no compression of the left renal, no blood and/or protein in the urine, being totally asymptomatic), a number of papers mentioned that severe POTS or OH is a symptom that some people also have with NCS, along with chronic fatigue too.
I can't find any statistics on the frequency of this but in reading about NCS in various forums, anecdotal evidence does indicate POTS to be a known co-morbidity in some people. A post by someone in one forum who also had severe POTS said that their Neurologist had mentioned to them that they had encountered several other patients with both POTS and NCS at their clinic.
The other aspect that cropped up in looking into this is that some papers suggest paediatric Chronic Fatigue Syndrome can also be related back to having NCS in also having symptoms of having orthostatic hypotension, postural tachycardia, or other autonomic dysfunction symptoms and chronic fatigue. Most of the papers are fairly dated now so again, not a lot of statistics are around on the subject.
Some children just grow out of this so it begs the question, does that maybe leave them open to developing this again later in life?
Patients' age for NCS can range from childhood to the seventh decade of life, but most symptomatic patients are in their second or third decade of life, it's more commonly reported in women and there's looking to be a second peak of NCS in middle-aged women, a somewhat similar pattern to ME/CFS too.
Because NCS itself can be totally asymptomatic, it is something to keep in mind with having POTS or issues of gastrointestinal disturbances and/or unexplained abdominal/pelvic pain.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2878259/ Nutcracker Phenomenon and Nutcracker Syndrome
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5101106/ Unusual Manifestation of Superior Mesenteric Artery Syndrome in a Female Patient: A Case Presentation
https://www.ncbi.nlm.nih.gov/pubmed/10749295 Does severe nutcracker phenomenon cause pediatric chronic fatigue?
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