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Superior Mesenteric Artery Syndrome: Clinical, Endoscopic, and Radiological Findings
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 presentat...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Hindawi
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6129792/ https://www.ncbi.nlm.nih.gov/pubmed/30224915 http://dx.doi.org/10.1155/2018/1937416 |
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author | Sinagra, Emanuele Raimondo, Dario Albano, Domenico Guarnotta, Valentina Blasco, Melania Testai, Sergio Marasà, Marta Mastrella, Vincenzo Alaimo, Valerio Bova, Valentina Albano, Giovanni Sorrentino, Dario Tomasello, Giovanni Cappello, Francesco Leone, Angelo Rossi, Francesca Galia, Massimo Lagalla, Roberto Midiri, Federico Morreale, Gaetano Cristian Amvrosiadis, Georgios Martorana, Guido Spampinato, Marcello Giuseppe Virgilio, Vittorio Midiri, Massimo |
author_facet | Sinagra, Emanuele Raimondo, Dario Albano, Domenico Guarnotta, Valentina Blasco, Melania Testai, Sergio Marasà, Marta Mastrella, Vincenzo Alaimo, Valerio Bova, Valentina Albano, Giovanni Sorrentino, Dario Tomasello, Giovanni Cappello, Francesco Leone, Angelo Rossi, Francesca Galia, Massimo Lagalla, Roberto Midiri, Federico Morreale, Gaetano Cristian Amvrosiadis, Georgios Martorana, Guido Spampinato, Marcello Giuseppe Virgilio, Vittorio Midiri, Massimo |
author_sort | Sinagra, Emanuele |
collection | PubMed |
description | 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/m(2), 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. |
format | Online Article Text |
id | pubmed-6129792 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Hindawi |
record_format | MEDLINE/PubMed |
spelling | pubmed-61297922018-09-17 Superior Mesenteric Artery Syndrome: Clinical, Endoscopic, and Radiological Findings Sinagra, Emanuele Raimondo, Dario Albano, Domenico Guarnotta, Valentina Blasco, Melania Testai, Sergio Marasà, Marta Mastrella, Vincenzo Alaimo, Valerio Bova, Valentina Albano, Giovanni Sorrentino, Dario Tomasello, Giovanni Cappello, Francesco Leone, Angelo Rossi, Francesca Galia, Massimo Lagalla, Roberto Midiri, Federico Morreale, Gaetano Cristian Amvrosiadis, Georgios Martorana, Guido Spampinato, Marcello Giuseppe Virgilio, Vittorio Midiri, Massimo Gastroenterol Res Pract Research Article 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/m(2), 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. Hindawi 2018-08-27 /pmc/articles/PMC6129792/ /pubmed/30224915 http://dx.doi.org/10.1155/2018/1937416 Text en Copyright © 2018 Emanuele Sinagra et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Sinagra, Emanuele Raimondo, Dario Albano, Domenico Guarnotta, Valentina Blasco, Melania Testai, Sergio Marasà, Marta Mastrella, Vincenzo Alaimo, Valerio Bova, Valentina Albano, Giovanni Sorrentino, Dario Tomasello, Giovanni Cappello, Francesco Leone, Angelo Rossi, Francesca Galia, Massimo Lagalla, Roberto Midiri, Federico Morreale, Gaetano Cristian Amvrosiadis, Georgios Martorana, Guido Spampinato, Marcello Giuseppe Virgilio, Vittorio Midiri, Massimo Superior Mesenteric Artery Syndrome: Clinical, Endoscopic, and Radiological Findings |
title | Superior Mesenteric Artery Syndrome: Clinical, Endoscopic, and Radiological Findings |
title_full | Superior Mesenteric Artery Syndrome: Clinical, Endoscopic, and Radiological Findings |
title_fullStr | Superior Mesenteric Artery Syndrome: Clinical, Endoscopic, and Radiological Findings |
title_full_unstemmed | Superior Mesenteric Artery Syndrome: Clinical, Endoscopic, and Radiological Findings |
title_short | Superior Mesenteric Artery Syndrome: Clinical, Endoscopic, and Radiological Findings |
title_sort | superior mesenteric artery syndrome: clinical, endoscopic, and radiological findings |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6129792/ https://www.ncbi.nlm.nih.gov/pubmed/30224915 http://dx.doi.org/10.1155/2018/1937416 |
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