Lakeland Regional Health Medical Center Lakeland, FL
Omar Zuhdi, MD1, Vasu Malhotra, DO1, Michael Sabina, DO2, Camila Villacreses, DO1, Paola Campillo, MD1, Adeeb Mustafa, MD1 1Lakeland Regional Health Medical Center, Lakeland, FL; 2Lakeland Regional, Lakeland Regional, FL Introduction: With the advent of GLP-1 and SGLT-2 medications for a variety of indications, including diabetes, obesity, obstructive sleep apnea, and metabolic associated steatohepatitis, there has been a large boom in the usage of these medications in recent years. While rarely reported in the literature, GLP-1 induced superior mesenteric artery syndrome (SMA syndrome) may become more prevalent with increased prescription of these medications.
Case Description/
Methods: The patient is a 77-year-old female, with a history of type 2 diabetes, who presented due to post-prandial epigastric pain, nausea, and vomiting. The patient reported significant weight loss over the last few months after starting dulaglutide. CT of the abdomen showed significant distention of the stomach and proximal duodenum. Narrowing of the mid to distal duodenum was noted as it passed between the aorta and SMA with decreased aortomesenteric angle. Superior mesenteric angle was noted to be approximately 13 degrees, compared to a normal SMA angle several months prior. Upper GI series showed abdominal distention with enlargement of the duodenal bulb and delayed passage of contrast from the duodenal bulb into the remaining portions of the duodenum. SMA symptoms were successfully treated with conservative management, improving with IV fluids, NG tube placement, and anti-nausea management. Follow-up endoscopy after resolution of symptoms showed no evidence of strictures or other structural causes of obstruction. Discussion: SMA syndrome is associated with compression of the third portion of the duodenum due to narrowing of the space between the SMA and aorta. SMA syndrome is often related to loss of the mesenteric fat pad and patients usually present with symptoms consistent with proximal small bowel obstruction. While weight loss is a common cause of SMA syndrome, other causes include anatomic abnormalities, cancer, AIDS, and malabsorption syndromes. SMA syndrome can be treated conservatively with nasogastric tube decompression and electrolyte replacement. If conservative management is not effective, surgical intervention may be required. Monitoring patients on GLP-1 and SGLT-2 medications is recommended to prevent proximal small bowel obstructions and prevent complications including electrolyte abnormalities, gastric perforation, and gastric pneumatosis. Increased awareness of SMA syndrome as a potential complication of GLP-1 and SGLT-2 medications is essential, especially as prescription of these medications becomes more widely prevalent.
Figure: Aortomesenteric angle of approximately 13 degrees noted, compared to a normal aortomesenteric angle several months prior.
Figure: Aortomesenteric angle of approximately 13 degrees noted, compared to a normal aortomesenteric angle several months prior.
Disclosures: Omar Zuhdi indicated no relevant financial relationships. Vasu Malhotra indicated no relevant financial relationships. Michael Sabina indicated no relevant financial relationships. Camila Villacreses indicated no relevant financial relationships. Paola Campillo indicated no relevant financial relationships. Adeeb Mustafa indicated no relevant financial relationships.
Omar Zuhdi, MD1, Vasu Malhotra, DO1, Michael Sabina, DO2, Camila Villacreses, DO1, Paola Campillo, MD1, Adeeb Mustafa, MD1. P6288 - GLP-1-Induced Superior Mesenteric Artery Syndrome: An Interesting Complication in the Age of GLP-1 and SGLT-2 Medications, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
