SMA syndrome, also known as superior mesenteric artery syndrome or Wilkie syndrome, is a rare digestive condition where part of the small intestine becomes compressed between two arteries. This compression blocks the normal flow of food through the digestive tract and can lead to uncomfortable symptoms.
This condition is often linked to significant weight loss or low body fat, which reduces the cushioning around the intestine. As a result, people may experience symptoms like abdominal pain, nausea, and difficulty eating, which can worsen the condition over time.
Treatment for SMA syndrome depends on how severe it is and usually starts with nutritional support and symptom control. In some cases, surgery may be needed, especially if symptoms do not improve with conservative care.
Main symptoms
SMA syndrome can cause digestive symptoms that often worsen after eating.
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Upper abdominal pain, especially after meals
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Nausea and vomiting
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Feeling full quickly when eating
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Bloating or abdominal distension
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Weight loss
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Loss of appetite
These symptoms may vary in intensity and can create a cycle where eating becomes difficult, leading to further weight loss and worsening of the condition.
Common causes
SMA syndrome is not contagious and is not transmitted from person to person. It is mainly caused by anatomical changes that reduce the space between the aorta and the superior mesenteric artery.
Rapid weight loss is one of the most common causes, as it reduces the fat tissue that normally cushions and protects the intestine. This can occur in situations such as eating disorders, severe illness, or strict dieting.
Certain medical or surgical conditions can also contribute to SMA syndrome. These include bariatric surgery or other abdominal procedures, spinal surgery or the use of body casts that affect posture, and chronic illnesses such as cancer.
In some cases, congenital or anatomical factors play a role. Some individuals naturally have a narrower angle between the arteries or differences in body structure that are present from birth.
All of these factors can reduce the space around the intestine and lead to compression, which interferes with normal digestion.
Confirming a diagnosis
Diagnosis of SMA syndrome is based on a combination of symptoms and imaging tests. Doctors usually suspect it when there is a history of significant weight loss along with ongoing digestive symptoms such as upper abdominal pain after eating, nausea, vomiting, early fullness, bloating, and continued weight loss.
Imaging exams such as CT scans, MRI, or ultrasound are used to confirm the diagnosis. These tests help measure the angle between the aorta and the superior mesenteric artery and show whether the intestine is compressed, as well as signs like dilation of the stomach or upper intestine.
Treatment options
Conservative treatment is usually the first approach and focuses on improving nutrition and promoting weight gain. This may include nutritional support, eating small and frequent meals that are easier to tolerate, and using positioning strategies such as lying on the side or bringing the knees to the chest after eating. These measures help restore the fat padding around the artery and can relieve compression in many cases.
Medications may also be used to help manage symptoms. These can include drugs to reduce nausea and vomiting, medications that improve stomach emptying, and acid-reducing drugs to prevent irritation of the digestive tract. These treatments support symptom control while the body recovers.
Surgical treatment may be needed if conservative measures are not effective or if symptoms are severe. One of the most common procedures is duodenojejunostomy, which creates a new pathway for food to bypass the compressed area. Other procedures may also be used to relieve pressure on the intestine depending on the individual case.
When to seek medical care
Medical evaluation is important if there is:
- Ongoing abdominal pain
- Frequent vomiting
- Unexplained weight loss.
These symptoms may indicate a serious digestive condition that requires prompt assessment, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Early diagnosis can help prevent complications and improve treatment outcomes.