POTS and MALS (abdominal vascular compression)

kangaSue

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This is something to be aware of for anyone with POTS and unexplained abdominal pain that I have only recently come across.

It appears that POTS commonly occurs in a lot of people who also have the co-morbidity of the abdominal vascular compression disorder called Median Arcuate Ligament Syndrome (MALS).
http://meetings.ssat.com/abstracts/2015/566.cgi

MALS also results in having abdominal pain, which can be severe, and GI dysmotilty issues so in anyone with POTS and GI problems, I suggest getting any doctor to listen to your bowel sounds for a bruit sound and get a Doppler Ultrasound test of your mesentery arteries even in the absence of a bruit to see if there is any discrepancies in your bowel blood flow velocities for the celiac and superior mesentery arteries.
https://gastroenterologen.no/2013/11/the-celiac-ganglion-artery-compression-syndrome-cgcs/

Looking further into it, having MALS and POTS together may be even more prevalent in those who also have Ehlers Danloss Syndrome.
 
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pattismith

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@kangaSue , your discoveries are fascinating, thanks a lot!

It seems that only very badly affected people are diagnosed and go under surgical treatment,
so other people that are less severely affected will have to manage it in another way...:thumbsup:
 
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kangaSue

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@kangaSue , your discoveries are fascinating, thanks a lot!
Hmmm, fascinating is what you call when it happens to someone else, bloody frustrating is the term when you are the possible recipient ;)
It seems that only very badly affected people are diagnosed and go under surgical treatment,
so other people that are less severely affected will have to manage it in another way.
I've seen this ruled out by doctors in a number of cases of just GI dysmotility because the degree of stenosis didn't match the text book's guideline of a 70% or more reduction in blood flow through the celiac artery. One vital point which is widely hypothesised in the literature that many doctors aren't aware of, or are dismissive of the fact that it can occur, is that because of the repeated episodes of intestinal ischemia/reperfusion injury, a situation called ischemia/reperfusion no-reflow phenomenon can develop so blood flow through the microvascular network is impaired too (non-occlusive mesenteric ischemia) leading to a more widespread lack of oxygen to the bowel during the digestion process.

This is probably something that I have affecting the large bowel in which I found a nitrate vasodilator med (nicorandil) helped a lot with symptoms of gastroparesis. Others have mentioned to me that vasodilating things like Viagra (or similar derivatives) or nitric oxide boosting supplements have helped them with GI dysmotility symptoms too, something which I would say has to do with boosting bowel artery blood flow and worth trying even with mild symptoms.
 

pattismith

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@kangaSue

I wonder if someone can have both MALS and Nutcracker;
The first one is worst in the supine position (especially after eating or drinking), whereas the second syndrome is worst in the erect position...It might not be fun to suffer from both!
 

kangaSue

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@kangaSue

I wonder if someone can have both MALS and Nutcracker;
The first one is worst in the supine position (especially after eating or drinking), whereas the second syndrome is worst in the erect position...It might not be fun to suffer from both!
@pattismith It doesn't appear to be as common as the SMA/ Nutcracker combination but yes, MALS/Nutcracker can occur together too.There's not many papers around about it and I found a greater mention of it occuring together in searching other forum discussions.
http://www.jvascsurg.org/article/S0741-5214(14)01205-1/fulltext

You can have a "floating kidney" (renal ptosis) with nutcracker Syndrome so more compression is applied to the SMA and left renal vein when you are in an upright position.