OpenHealth Q&A

26-Year-Old Female with Weight Loss and GI Symptoms: Is it SMAS?

Hello everyone, I am a 26-year-old woman (assigned female at birth, standing 5'9" and weighing 138 pounds, a steady decrease over 6 months), and I have been grappling with a range of gastrointestinal issues that have become quite distressing. While I understand that Superior Mesenteric Artery Syndrome (SMAS) is uncommon, the reality is that I am losing weight, feeling unwell, and I’m desperately seeking answers that might explain my situation. **Symptoms I’ve Been Experiencing:** - Unplanned weight reduction that began after a period of significant weight gain, rapidly transforming into quick weight loss that has slowed but persists. - Oily stools. - A varying gastrointestinal pattern: experiencing constipation for 2-3 days followed by 1-2 days of urgent, oily diarrhea. - Nausea that typically appears mid-morning (definitely not pregnant). - A sense of fatigue post-meals; large portions make me feel quite ill for hours thereafter. - Positional sensitivity: sometimes, I notice a slight improvement when lying on my left side or stomach, although I have only recently started to pay attention to this. **Diagnoses I Currently Have:** - Diagnosed with Postural Orthostatic Tachycardia Syndrome (POTS). - Suspected hypermobile Ehlers-Danlos Syndrome (hEDS) — while not officially diagnosed, I demonstrate hypermobility, bruise easily, and exhibit symptoms suggesting connective tissue issues. Genetic testing has ruled out classic EDS. **Tests Conducted:** - Upper and lower gastrointestinal endoscopy – results were normal. - MRCP – showed no significant findings. - Chest CT – clear, no abnormalities detected. - Abdominal X-ray – indicated constipation and stool burden. - Laboratory tests – all within normal ranges. - Fecal elastase – measuring 89 (below 40 was concerning), but the pancreatic specialist dismissed the possibility of Exocrine Pancreatic Insufficiency (EPI) due to no pancreatic damage, nor was there evidence of pancreatitis, Cystic Fibrosis, Celiac Disease, Ulcerative Colitis, Crohn’s, or IBS/IBD. They suggested I stop enzyme therapy. I was advised to return if symptoms persist, potentially considering testing for Small Intestinal Bacterial Overgrowth (SIBO) at that point. **Current Medications Include:** - Zoloft 100 mg (gradually decreasing). - Effexor 75 mg (gradually increasing). - Adderall XR and IR (20 mg and 5 mg, respectively). - Trazodone (as needed for sleep, 50 mg). - Xyzal 5 mg. - Fiber supplements (husk). - Kyleena IUD. **Reasons for Considering SMAS:** - The combination of alternating constipation, steatorrhea, weight loss, and nausea could indicate partial obstruction of the duodenum. - SMAS tends to occur more frequently in slender females or those who have undergone fast weight loss. - Although I haven’t undergone a CT or MR angiogram to evaluate the angle of my superior mesenteric artery or aortomesenteric distance, I am contemplating whether to request these scans. **My Main Inquiry:** Could my symptoms indicate SMAS or perhaps another condition like Median Arcuate ligament syndrome (MALS)? I am cautious about self-diagnosing or pursuing rare conditions. However, when faced with persistent symptoms that don’t point to any other diagnosis, I believe it is important to explore all possibilities. Thank you for taking the time to read my lengthy post. I am earnestly seeking answers, as I believe each health challenge has a root cause, and I am determined to uncover it.

Answers (1)

7/25/2025, 8:40:50 PM

OpenHealth AI

Your symptoms are concerning and could potentially indicate several underlying conditions, including Superior Mesenteric Artery Syndrome (SMAS) or other gastrointestinal disorders. Given your weight loss, oily stools, and gastrointestinal issues, it’s understandable that you are seeking clarity.

Explanation

SMAS occurs when the superior mesenteric artery compresses the duodenum, leading to a partial obstruction. It's relatively rare but can present with symptoms like you described—weight loss, nausea, and changes in bowel habits. Your mention of positional sensitivity is interesting, as some patients with SMAS report symptom relief when lying in certain positions.

However, it's also essential to consider other potential conditions such as Small Intestinal Bacterial Overgrowth (SIBO), which can cause similar digestive symptoms. You’ve noted the variability in your GI symptoms and the presence of steatorrhea (oily stools), which does align with possible malabsorption issues.

Next Steps

1. Symptom Monitoring: Keep a detailed log of your symptoms. Record when they occur, their severity, and any dietary factors that seem to influence them. This information can be valuable for your healthcare provider.

2. Request Further Imaging: Given your concerns regarding SMAS, discuss with your physician the possibility of further imaging studies, such as a CT or MR angiogram, to assess the anatomy of your superior mesenteric artery and any possible obstructions.

3. Consider SIBO Testing: Since there’s a suggestion of malabsorption, testing for SIBO could be informative. SIBO can cause symptoms similar to yours and can often be treated effectively.

4. Dietary Adjustments: Until you can get a clearer picture of your condition, consider making dietary changes:

   • Eat smaller, more frequent meals to prevent feeling ill after larger meals.
   • Avoid high-fat foods since they can exacerbate steatorrhea.
   • Incorporate easily digestible foods and keep a food diary to help identify any specific food intolerances.

5. Follow Up with Specialists: If your symptoms persist or worsen, seeking a second opinion from a gastroenterologist who specializes in motility disorders may provide further insights.

6. Stay Hydrated: Ensure you’re drinking plenty of fluids, especially if you’re experiencing diarrhea, to stay hydrated.

It’s crucial to pursue an accurate diagnosis while remaining open to various possibilities, including rare conditions. You deserve effective treatment, and your proactive approach to your health is commendable. Please take care, and continue advocating for yourself until you find the answers you need.