{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T13:57:34Z","timestamp":1790517454137,"version":"4.1.0"},"reference-count":18,"publisher":"Wiley","license":[{"start":{"date-parts":[[2018,8,27]],"date-time":"2018-08-27T00:00:00Z","timestamp":1535328000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gastroenterology Research and Practice"],"published-print":{"date-parts":[[2018,8,27]]},"abstract":"<jats:p><jats:italic>Background<\/jats:italic>. 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. <jats:italic>Aims and Methods<\/jats:italic>. 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). <jats:italic>Results<\/jats:italic>. The prevalence of SMA syndrome was 0.005%. Median age and body mass index were 23.5 years and 21.5\u2009kg\/m<jats:sup>2<\/jats:sup>, respectively. Symptoms developed between 6 and 24 months. Median aortomesenteric angle and aorta-SMA distance were 22 and 6\u2009mm, respectively. All patients improved on conservative treatment. In our series, a marked (&gt;5\u2009kg) weight loss (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\"><mml:mi>p<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.006<\/mml:mn><\/mml:math>) and a long-standing presentation (more than six months in 80% of patients) (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\"><mml:mi>p<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.002<\/mml:mn><\/mml:math>) are significantly related to a diagnosis of confirmed SMA syndrome at CECT after an endoscopic suspicion. A \u201cresembling postprandial distress syndrome dyspepsia\u201d presentation may be helpful to the endoscopist in suspecting a latent SMA syndrome (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M3\"><mml:mi>p<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.02<\/mml:mn><\/mml:math>). The narrowing of both the aortomesenteric angle (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M4\"><mml:mi>p<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.001<\/mml:mn><\/mml:math>) and the aortomesenteric distance (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M5\"><mml:mi>p<\/mml:mi><mml:mo>&lt;<\/mml:mo><mml:mn>0.001<\/mml:mn><\/mml:math>) 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. <jats:italic>Conclusion<\/jats:italic>. 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.<\/jats:p>","DOI":"10.1155\/2018\/1937416","type":"journal-article","created":{"date-parts":[[2018,8,27]],"date-time":"2018-08-27T19:44:02Z","timestamp":1535399042000},"page":"1-7","source":"Crossref","is-referenced-by-count":36,"title":["Superior Mesenteric Artery Syndrome: Clinical, Endoscopic, and Radiological Findings"],"prefix":"10.1155","volume":"2018","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8528-0384","authenticated-orcid":true,"given":"Emanuele","family":"Sinagra","sequence":"first","affiliation":[{"name":"Gastroenterology and Endoscopy Unit, Fondazione Istituto G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefal\u00f9, Italy"},{"name":"Euro-Mediterranean Institute of Science and Technology (IEMEST), 90100 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario","family":"Raimondo","sequence":"additional","affiliation":[{"name":"Gastroenterology and Endoscopy Unit, Fondazione Istituto G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefal\u00f9, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Albano","sequence":"additional","affiliation":[{"name":"Department of Radiology, DIBIMED, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Guarnotta","sequence":"additional","affiliation":[{"name":"Section of Cardio-Respiratory and Endocrine-Metabolic Diseases, Biomedical Department of Internal and Specialist Medicine (DIBIMIS), University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melania","family":"Blasco","sequence":"additional","affiliation":[{"name":"Internal Medicine Unit, Fondazione Istituto G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefal\u00f9, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Testai","sequence":"additional","affiliation":[{"name":"Radiology Unit, Fondazione Istituto G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefal\u00f9, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Maras\u00e0","sequence":"additional","affiliation":[{"name":"Radiology Unit, Fondazione Istituto G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefal\u00f9, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Mastrella","sequence":"additional","affiliation":[{"name":"Radiology Unit, Fondazione Istituto G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefal\u00f9, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerio","family":"Alaimo","sequence":"additional","affiliation":[{"name":"Radiology Unit, Fondazione Istituto G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefal\u00f9, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Bova","sequence":"additional","affiliation":[{"name":"Radiology Unit, Fondazione Istituto G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefal\u00f9, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Albano","sequence":"additional","affiliation":[{"name":"Radiology Unit, Fondazione Istituto G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefal\u00f9, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario","family":"Sorrentino","sequence":"additional","affiliation":[{"name":"Radiology Unit, Fondazione Istituto G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefal\u00f9, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3071-822X","authenticated-orcid":true,"given":"Giovanni","family":"Tomasello","sequence":"additional","affiliation":[{"name":"Euro-Mediterranean Institute of Science and Technology (IEMEST), 90100 Palermo, Italy"},{"name":"Department of Experimental Biomedicine and Clinical Neuroscience, Section of Human Anatomy, University of Palermo, 90100 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Cappello","sequence":"additional","affiliation":[{"name":"Euro-Mediterranean Institute of Science and Technology (IEMEST), 90100 Palermo, Italy"},{"name":"Department of Experimental Biomedicine and Clinical Neuroscience, Section of Human Anatomy, University of Palermo, 90100 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Leone","sequence":"additional","affiliation":[{"name":"BioNec, Section of Histology, Department of Experimental and Clinical Neurosciences, University of Palermo, Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Rossi","sequence":"additional","affiliation":[{"name":"Gastroenterology and Endoscopy Unit, Fondazione Istituto G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefal\u00f9, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3913-6290","authenticated-orcid":true,"given":"Massimo","family":"Galia","sequence":"additional","affiliation":[{"name":"Department of Radiology, DIBIMED, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Lagalla","sequence":"additional","affiliation":[{"name":"Department of Radiology, DIBIMED, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9386-2130","authenticated-orcid":true,"given":"Federico","family":"Midiri","sequence":"additional","affiliation":[{"name":"Department of Radiology, DIBIMED, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaetano Cristian","family":"Morreale","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, PO. 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