Rubela Ray, MD1, Darshankumar Raval, MD2, Kristina Patel, MD3 1University of Wyoming, Cheyenne, WY; 2Elmhurst Hospital Center / Icahn School of Medicine at Mount Sinai, Youngstown, OH; 3University of Arkansas, Texarkana, AR Introduction: Women, particularly women of color, often face implicit bias in clinical evaluation, leading to the dismissal of serious gastrointestinal (GI) complaints. Median Arcuate Ligament Syndrome (MALS), a rare but treatable cause of postprandial abdominal pain, predominantly affects young women. Here, we report a case in which a Black woman’s severe GI pain was repeatedly misattributed to psychological causes, delaying a potentially life-altering diagnosis.
Case Description/
Methods: A 31-year-old Black woman with no significant medical history presented with an 18-month history of epigastric pain, early satiety, bloating, nausea, and 11-kg weight loss. Symptoms were worse after meals. She visited multiple clinics and emergency departments. Despite reporting significant functional decline, she was repeatedly told her symptoms were likely due to anxiety, stress, or irritable bowel syndrome. She was prescribed antacids and SSRIs without further investigation.
H. pylori testing and routine labs were unremarkable. An upper endoscopy showed mild antral gastritis. Abdominal ultrasound was normal. Only after the patient insisted on further evaluation did a CT angiogram reveal significant celiac artery compression consistent with MALS. A diagnostic celiac plexus block offered immediate relief, and she underwent successful laparoscopic median arcuate ligament release. At follow-up, her pain had resolved, and weight gain resumed. Discussion: This case illustrates how racial and gender biases can contribute to delays in diagnosing serious GI pathology. Despite classic MALS symptoms, this patient’s complaints were repeatedly dismissed. The overattribution of abdominal pain in women—especially Black women—to psychological causes reflects a systemic disparity. MALS, though rare, must be considered in patients with postprandial epigastric pain and negative routine workup.
Clinicians must remain vigilant to avoid diagnostic overshadowing, especially in marginalized populations. Early use of advanced imaging could have expedited her diagnosis and spared months of suffering. Equity in GI care demands culturally sensitive, bias-aware listening and diagnostic diligence.
Conclusion: GI pain in Black women is frequently underestimated or misdiagnosed due to implicit bias. This case underscores the importance of equitable diagnostic practices and awareness of uncommon GI conditions like MALS. Listening without assumptions can change lives—and outcomes.
Disclosures: Rubela Ray indicated no relevant financial relationships. Darshankumar Raval indicated no relevant financial relationships. Kristina Patel indicated no relevant financial relationships.
Rubela Ray, MD1, Darshankumar Raval, MD2, Kristina Patel, MD3. P6397 - When Pain Is Silenced: Missed Diagnosis of Celiac Artery Compression Syndrome in a Young Black Woman Due to Racial and Gender Bias, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
