{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T12:12:17Z","timestamp":1788437537323,"version":"build-2803163510"},"reference-count":32,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. pediatr. gastroenterol. nutr."],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Median arcuate ligament syndrome (MALS) involves compression of the celiac artery and presents with gastrointestinal symptoms. We evaluated outcomes after surgical versus conservative management in pediatric MALS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We reviewed charts of symptomatic patients aged 7\u201321 years diagnosed by ultrasound and\/or computed tomography angiogram. Outcomes were categorized as resolved, improved, unchanged, or worsened at most recent follow\u2010up and compared between conservative and surgical treatment groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 34 patients (median age 15 years, 79% female, 94% Caucasian), common symptoms included abdominal pain (85%) and nausea (71%); 36% had psychiatric disorders, 56% met criteria for disorders of gut\u2013brain interaction (DGBI). Ten received conservative therapy (100% pharmacologic, 80% behavioral, 30% botulinum toxin, 20% neurostimulation) with a median follow\u2010up of 5 months. Outcomes were resolution (20%), improvement (40%), unchanged (40%), and none worsened. Of 24 surgical patients (median hospital stays: 4 days), outcomes were: resolution (21%), improved (33%), unchanged (17%), worsened (29%); not significantly different from conservative group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.21). Postoperative complications occurred in 21%. At median 20\u2010day postoperative follow\u2010up, 52% reported resolution, 35% improved, 9% unchanged, 4% worsened. Pain location differed by group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005); other demographics and long\u2010term outcomes did not (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). Baseline comorbidities and treatment modalities were not significantly associated with outcome (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In our cohort, 60% of children with MALS improved with conservative DGBI\u2010directed therapy and 54% improved with decompression surgery at long\u2010term follow\u2010up, despite a robust short\u2010term postoperative response (87%). Prospective studies are needed to guide patient selection and assess long\u2010term outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jpn3.70486","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T07:41:49Z","timestamp":1781854909000},"page":"397-403","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes of surgical versus conservative treatment in pediatric median arcuate ligament syndrome"],"prefix":"10.1002","volume":"83","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8740-0679","authenticated-orcid":false,"given":"Mohamad","family":"Abi Nassif","sequence":"first","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology and Nutrition Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Gurria","sequence":"additional","affiliation":[{"name":"Division of Pediatric General and Thoracic Surgery Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"},{"name":"University of Cincinnati College of Medicine Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danny","family":"Mallon","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology and Nutrition Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"},{"name":"University of Cincinnati College of Medicine Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashmi","family":"Sahay","sequence":"additional","affiliation":[{"name":"Division of Biostatistics Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lev","family":"Dorfman","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology and Nutrition Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Vore","sequence":"additional","affiliation":[{"name":"Division of Pediatric General and Thoracic Surgery Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Hardy","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology and Nutrition Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlin","family":"Whaley","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology and Nutrition Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"},{"name":"University of Cincinnati College of Medicine Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Nasr","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology and Nutrition Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"},{"name":"University of Cincinnati College of Medicine Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0896-079X","authenticated-orcid":false,"given":"Neha R.","family":"Santucci","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology and Nutrition Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"},{"name":"University of Cincinnati College of Medicine Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-191702000-00006"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2019.11.012"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.21037\/cdt-20-846"},{"issue":"1","key":"e_1_2_8_5_1","first-page":"95","article-title":"Chronic abdominal pain, an overlooked diagnosis of median arcuate ligament syndrome (MALS)","volume":"43","author":"Nikolova D","year":"2022","journal-title":"Pril (Makedon Akad Nauk Umet Odd Med Nauki)"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.2147\/VHRM.S350841"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.5582\/irdr.2019.01031"},{"issue":"2","key":"e_1_2_8_8_1","article-title":"Median arcuate ligament syndrome","volume":"14","author":"Iobst 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