Acid Reflux and Superior Mesenteric Axis Syndrome

[Rickvin]

After 6 months of tests and checks my father was eventually diagnosed with gastritis & acid reflux as well as food blockage due to superior mesenteric axis syndrome.

Often he feels spasms normally before meals, and after meals he has a feeling of indigestion. He has lost about 5 kg in the last 5 months as his diet has been almost 1/2 due to the indigestion problem after meals, causing him to reduce his food intake.

The doctor has said he would prefer my father to leave the problem and learn to live with it rather than go through surgery as this is a very rare problem. Has anybody come across this problem and if the person has had surgery to improve the condition? My father is 64 years this year.

[Kevin Pho, MD]

Conservative initial treatment is recommended in all patients with SMA syndrome; this includes adequate nutrition, GI decompression, and proper positioning of the patient after eating (ie, left lateral decubitus, prone, or knee-to-chest position).

Enteral feeding through a tube passed distal to the obstruction or total parenteral nutrition can be an effective adjunct in treatment of patients with rapid severe weight loss. Metoclopramide treatment may be beneficial.

Surgical intervention is indicated when conservative measures are ineffective, particularly in patients with a long history of progressive weight loss, pronounced duodenal dilatation with stasis, and complicating peptic ulcer disease. Duodenojejunostomy is the most frequently used procedure, and it is successful in about 90% of cases.  This can be discussed with your surgeon

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[surgeon]

The correct term is "superior mesenteric artery syndrome." It means an artery is crossing over the duodenum (the first part of the intestine after food leaves the stomach), causing it to be partially blocked to passage of food. Whereas it's true it's not very common, the surgery to correct it is usually pretty easy and, as these things go, low risk -- assuming the patient's health is otherwise ok. What's usually done is a simple sort of bypass around the obstruction, done by sewing intestine above the obstruction to intestine below the obstruction in a side-to-side fashion. (Imagine stepping on a hose: pick up the hose on either side of your foot, place the loops in your hand against each other, make a hole between them: the water gets from the one loop into the other without ever moving your foot. Simple surgery.)

[Rickvin]

Dear Surgeon,

Do we need to see a vascular surgeon or any normal surgeon might be good enough?

Thank you

[surgeon]

The procedure would be done, usually, by a general surgeon: it's intestinal work, not vascular work. Many vascular surgeons also do general surgery, however; general surgery training is a requirement for vascular training.