Superior mesenteric artery syndrome: Clinical, endoscopic, and radiological findings

Domenico Albano, Angelo Leone, Valentina Guarnotta, Massimo Galia, Gaetano Cristian Morreale, Roberto Lagalla, Massimo Midiri, Francesco Cappello, Giovanni Tomasello, Dario Raimondo, Valerio Alaimo, Marcello Giuseppe Spampinato, Vittorio Virgilio, Valentina Bova, Emanuele Sinagra, Georgios Amvrosiadis, Dario Sorrentino, Marta Marasà, Gaetano Cristian Morreale, Guido MartoranaVincenzo Mastrella, Francesca Rossi, Giovanni Tomasello, Melania Blasco, Giovanni Albano, Sergio Testai, Francesco Cappello, Dario Raimondo, Federico Midiri, Francesco Cappello, Georgios Amvrosiadis, Guido Martorana, Marta Marasa', Sergio Testai, Valentina Bova, Valerio Alaimo, Vincenzo Mastrella

Risultato della ricerca: Article

1 Citazione (Scopus)

Abstract

Background. The superior mesenteric artery (SMA) syndrome is a rare entity presenting with upper gastrointestinal tract obstruction and weight loss. Studies to determine the optimal methods of diagnosis and treatment are required. Aims and Methods. This study aims at analyzing the clinical presentation, diagnosis, and management of SMA syndrome. Ten cases of SMA syndrome out of 2074 esophagogastroduodenoscopies were suspected. A contrast-enhanced computed tomography (CECT) scan was performed to confirm the diagnosis. After, a gastroenterologist and a nutritionist personalized the therapy. Furthermore, we compared the demographical, clinical, endoscopic, and radiological parameters of these cases with a control group consisting of 10 cases out of 2380 EGDS of initially suspected (but not radiologically confirmed) SMA over a follow-up 2-year period (2015-2016). Results. The prevalence of SMA syndrome was 0.005%. Median age and body mass index were 23.5 years and 21.5 kg/m2, respectively. Symptoms developed between 6 and 24 months. Median aortomesenteric angle and aorta-SMA distance were 22 and 6 mm, respectively. All patients improved on conservative treatment. In our series, a marked (>5 kg) weight loss (p=0.006) and a long-standing presentation (more than six months in 80% of patients) (p=0.002) are significantly related to a diagnosis of confirmed SMA syndrome at CECT after an endoscopic suspicion. A "resembling postprandial distress syndrome dyspepsia" presentation may be helpful to the endoscopist in suspecting a latent SMA syndrome (p=0.02). The narrowing of both the aortomesenteric angle (p=0.001) and the aortomesenteric distance (p<0.001) was significantly associated with the diagnosis of SMA after an endoscopic suspicion; however, the narrowing of the aortomesenteric distance seemed to be more accurate, rather than the narrowing of the aortomesenteric angle. Conclusion. SMA syndrome represents a diagnostic and therapeutic challenge. Our results show the following findings: the importance of the endoscopic suspicion of SMA syndrome; the preponderance of a long-standing and chronic onset; a female preponderance; the importance of the nutritional counseling for the treatment; no need of surgical intervention; and better diagnostic accuracy of the narrowing of the aorta-SMA distance. Larger prospective studies are needed to clarify the best diagnosis and management of the SMA syndrome.
Lingua originaleEnglish
Numero di pagine7
RivistaDefault journal
Volume2018
Stato di pubblicazionePublished - 2018

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

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Superior mesenteric artery syndrome: Clinical, endoscopic, and radiological findings. / Albano, Domenico; Leone, Angelo; Guarnotta, Valentina; Galia, Massimo; Morreale, Gaetano Cristian; Lagalla, Roberto; Midiri, Massimo; Cappello, Francesco; Tomasello, Giovanni; Raimondo, Dario; Alaimo, Valerio; Spampinato, Marcello Giuseppe; Virgilio, Vittorio; Bova, Valentina; Sinagra, Emanuele; Amvrosiadis, Georgios; Sorrentino, Dario; Marasà, Marta; Morreale, Gaetano Cristian; Martorana, Guido; Mastrella, Vincenzo; Rossi, Francesca; Tomasello, Giovanni; Blasco, Melania; Albano, Giovanni; Testai, Sergio; Cappello, Francesco; Raimondo, Dario; Midiri, Federico; Cappello, Francesco; Amvrosiadis, Georgios; Martorana, Guido; Marasa', Marta; Testai, Sergio; Bova, Valentina; Alaimo, Valerio; Mastrella, Vincenzo.

In: Default journal, Vol. 2018, 2018.

Risultato della ricerca: Article

Albano, D, Leone, A, Guarnotta, V, Galia, M, Morreale, GC, Lagalla, R, Midiri, M, Cappello, F, Tomasello, G, Raimondo, D, Alaimo, V, Spampinato, MG, Virgilio, V, Bova, V, Sinagra, E, Amvrosiadis, G, Sorrentino, D, Marasà, M, Morreale, GC, Martorana, G, Mastrella, V, Rossi, F, Tomasello, G, Blasco, M, Albano, G, Testai, S, Cappello, F, Raimondo, D, Midiri, F, Cappello, F, Amvrosiadis, G, Martorana, G, Marasa', M, Testai, S, Bova, V, Alaimo, V & Mastrella, V 2018, 'Superior mesenteric artery syndrome: Clinical, endoscopic, and radiological findings', Default journal, vol. 2018.
Albano, Domenico ; Leone, Angelo ; Guarnotta, Valentina ; Galia, Massimo ; Morreale, Gaetano Cristian ; Lagalla, Roberto ; Midiri, Massimo ; Cappello, Francesco ; Tomasello, Giovanni ; Raimondo, Dario ; Alaimo, Valerio ; Spampinato, Marcello Giuseppe ; Virgilio, Vittorio ; Bova, Valentina ; Sinagra, Emanuele ; Amvrosiadis, Georgios ; Sorrentino, Dario ; Marasà, Marta ; Morreale, Gaetano Cristian ; Martorana, Guido ; Mastrella, Vincenzo ; Rossi, Francesca ; Tomasello, Giovanni ; Blasco, Melania ; Albano, Giovanni ; Testai, Sergio ; Cappello, Francesco ; Raimondo, Dario ; Midiri, Federico ; Cappello, Francesco ; Amvrosiadis, Georgios ; Martorana, Guido ; Marasa', Marta ; Testai, Sergio ; Bova, Valentina ; Alaimo, Valerio ; Mastrella, Vincenzo. / Superior mesenteric artery syndrome: Clinical, endoscopic, and radiological findings. In: Default journal. 2018 ; Vol. 2018.
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title = "Superior mesenteric artery syndrome: Clinical, endoscopic, and radiological findings",
abstract = "Background. The superior mesenteric artery (SMA) syndrome is a rare entity presenting with upper gastrointestinal tract obstruction and weight loss. Studies to determine the optimal methods of diagnosis and treatment are required. Aims and Methods. This study aims at analyzing the clinical presentation, diagnosis, and management of SMA syndrome. Ten cases of SMA syndrome out of 2074 esophagogastroduodenoscopies were suspected. A contrast-enhanced computed tomography (CECT) scan was performed to confirm the diagnosis. After, a gastroenterologist and a nutritionist personalized the therapy. Furthermore, we compared the demographical, clinical, endoscopic, and radiological parameters of these cases with a control group consisting of 10 cases out of 2380 EGDS of initially suspected (but not radiologically confirmed) SMA over a follow-up 2-year period (2015-2016). Results. The prevalence of SMA syndrome was 0.005{\%}. Median age and body mass index were 23.5 years and 21.5 kg/m2, respectively. Symptoms developed between 6 and 24 months. Median aortomesenteric angle and aorta-SMA distance were 22 and 6 mm, respectively. All patients improved on conservative treatment. In our series, a marked (>5 kg) weight loss (p=0.006) and a long-standing presentation (more than six months in 80{\%} of patients) (p=0.002) are significantly related to a diagnosis of confirmed SMA syndrome at CECT after an endoscopic suspicion. A {"}resembling postprandial distress syndrome dyspepsia{"} presentation may be helpful to the endoscopist in suspecting a latent SMA syndrome (p=0.02). The narrowing of both the aortomesenteric angle (p=0.001) and the aortomesenteric distance (p<0.001) was significantly associated with the diagnosis of SMA after an endoscopic suspicion; however, the narrowing of the aortomesenteric distance seemed to be more accurate, rather than the narrowing of the aortomesenteric angle. Conclusion. SMA syndrome represents a diagnostic and therapeutic challenge. Our results show the following findings: the importance of the endoscopic suspicion of SMA syndrome; the preponderance of a long-standing and chronic onset; a female preponderance; the importance of the nutritional counseling for the treatment; no need of surgical intervention; and better diagnostic accuracy of the narrowing of the aorta-SMA distance. Larger prospective studies are needed to clarify the best diagnosis and management of the SMA syndrome.",
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TY - JOUR

T1 - Superior mesenteric artery syndrome: Clinical, endoscopic, and radiological findings

AU - Albano, Domenico

AU - Leone, Angelo

AU - Guarnotta, Valentina

AU - Galia, Massimo

AU - Morreale, Gaetano Cristian

AU - Lagalla, Roberto

AU - Midiri, Massimo

AU - Cappello, Francesco

AU - Tomasello, Giovanni

AU - Raimondo, Dario

AU - Alaimo, Valerio

AU - Spampinato, Marcello Giuseppe

AU - Virgilio, Vittorio

AU - Bova, Valentina

AU - Sinagra, Emanuele

AU - Amvrosiadis, Georgios

AU - Sorrentino, Dario

AU - Marasà, Marta

AU - Morreale, Gaetano Cristian

AU - Martorana, Guido

AU - Mastrella, Vincenzo

AU - Rossi, Francesca

AU - Tomasello, Giovanni

AU - Blasco, Melania

AU - Albano, Giovanni

AU - Testai, Sergio

AU - Cappello, Francesco

AU - Raimondo, Dario

AU - Midiri, Federico

AU - Cappello, Francesco

AU - Amvrosiadis, Georgios

AU - Martorana, Guido

AU - Marasa', Marta

AU - Testai, Sergio

AU - Bova, Valentina

AU - Alaimo, Valerio

AU - Mastrella, Vincenzo

PY - 2018

Y1 - 2018

N2 - Background. The superior mesenteric artery (SMA) syndrome is a rare entity presenting with upper gastrointestinal tract obstruction and weight loss. Studies to determine the optimal methods of diagnosis and treatment are required. Aims and Methods. This study aims at analyzing the clinical presentation, diagnosis, and management of SMA syndrome. Ten cases of SMA syndrome out of 2074 esophagogastroduodenoscopies were suspected. A contrast-enhanced computed tomography (CECT) scan was performed to confirm the diagnosis. After, a gastroenterologist and a nutritionist personalized the therapy. Furthermore, we compared the demographical, clinical, endoscopic, and radiological parameters of these cases with a control group consisting of 10 cases out of 2380 EGDS of initially suspected (but not radiologically confirmed) SMA over a follow-up 2-year period (2015-2016). Results. The prevalence of SMA syndrome was 0.005%. Median age and body mass index were 23.5 years and 21.5 kg/m2, respectively. Symptoms developed between 6 and 24 months. Median aortomesenteric angle and aorta-SMA distance were 22 and 6 mm, respectively. All patients improved on conservative treatment. In our series, a marked (>5 kg) weight loss (p=0.006) and a long-standing presentation (more than six months in 80% of patients) (p=0.002) are significantly related to a diagnosis of confirmed SMA syndrome at CECT after an endoscopic suspicion. A "resembling postprandial distress syndrome dyspepsia" presentation may be helpful to the endoscopist in suspecting a latent SMA syndrome (p=0.02). The narrowing of both the aortomesenteric angle (p=0.001) and the aortomesenteric distance (p<0.001) was significantly associated with the diagnosis of SMA after an endoscopic suspicion; however, the narrowing of the aortomesenteric distance seemed to be more accurate, rather than the narrowing of the aortomesenteric angle. Conclusion. SMA syndrome represents a diagnostic and therapeutic challenge. Our results show the following findings: the importance of the endoscopic suspicion of SMA syndrome; the preponderance of a long-standing and chronic onset; a female preponderance; the importance of the nutritional counseling for the treatment; no need of surgical intervention; and better diagnostic accuracy of the narrowing of the aorta-SMA distance. Larger prospective studies are needed to clarify the best diagnosis and management of the SMA syndrome.

AB - Background. The superior mesenteric artery (SMA) syndrome is a rare entity presenting with upper gastrointestinal tract obstruction and weight loss. Studies to determine the optimal methods of diagnosis and treatment are required. Aims and Methods. This study aims at analyzing the clinical presentation, diagnosis, and management of SMA syndrome. Ten cases of SMA syndrome out of 2074 esophagogastroduodenoscopies were suspected. A contrast-enhanced computed tomography (CECT) scan was performed to confirm the diagnosis. After, a gastroenterologist and a nutritionist personalized the therapy. Furthermore, we compared the demographical, clinical, endoscopic, and radiological parameters of these cases with a control group consisting of 10 cases out of 2380 EGDS of initially suspected (but not radiologically confirmed) SMA over a follow-up 2-year period (2015-2016). Results. The prevalence of SMA syndrome was 0.005%. Median age and body mass index were 23.5 years and 21.5 kg/m2, respectively. Symptoms developed between 6 and 24 months. Median aortomesenteric angle and aorta-SMA distance were 22 and 6 mm, respectively. All patients improved on conservative treatment. In our series, a marked (>5 kg) weight loss (p=0.006) and a long-standing presentation (more than six months in 80% of patients) (p=0.002) are significantly related to a diagnosis of confirmed SMA syndrome at CECT after an endoscopic suspicion. A "resembling postprandial distress syndrome dyspepsia" presentation may be helpful to the endoscopist in suspecting a latent SMA syndrome (p=0.02). The narrowing of both the aortomesenteric angle (p=0.001) and the aortomesenteric distance (p<0.001) was significantly associated with the diagnosis of SMA after an endoscopic suspicion; however, the narrowing of the aortomesenteric distance seemed to be more accurate, rather than the narrowing of the aortomesenteric angle. Conclusion. SMA syndrome represents a diagnostic and therapeutic challenge. Our results show the following findings: the importance of the endoscopic suspicion of SMA syndrome; the preponderance of a long-standing and chronic onset; a female preponderance; the importance of the nutritional counseling for the treatment; no need of surgical intervention; and better diagnostic accuracy of the narrowing of the aorta-SMA distance. Larger prospective studies are needed to clarify the best diagnosis and management of the SMA syndrome.

KW - Gastroenterology

KW - Hepatology

UR - http://hdl.handle.net/10447/350728

UR - http://www.hindawi.com/journals/grp/

M3 - Article

VL - 2018

JO - Default journal

JF - Default journal

ER -