Clinical presentation

Clinical presentation of patients with MALS can vary from severe pain in the upper abdomen associated with meals and exercise, to more subtle abdominal discomfort, nausea, and vomiting. Because these gastrointestinal symptoms are not specific to MALS and can also occur with a variety of other gastrointestinal or abdominal disorders, the diagnosis can be challenging. Patients often require an extensive investigation with multiple consultations and diagnostic tests. In addition, because evidence of compression or narrowing of the celiac artery by the median arcuate ligament is not sufficient to establish the diagnosis and is found in up to 40% of the general population, the finding of narrowing itself does not determine the diagnosis. MALS is often considered a “diagnosis of exclusion”, which is determined after other gastrointestinal disorders have been ruled out, and is strongly supported by the presence of severe epigastric pain with concomitant compression or narrowing of the celiac artery.


  • Pain between the ribs and below the sternum
  • Pain in either the side or back
  • Pain after eating and/or after exercise

Additional nonspecific symptoms of MALS:

  • Fatigue after eating
  • Nausea/vomiting
  • Weight loss
  • Constipation/diarrhea