Vomiting, belching, bilious vomiting
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Vomiting, belching, bilious vomiting

Disclaimer: The following explanation is focused on vascular compression syndromes. Of course, and more frequently other explanations may apply. In any case, please turn to your doctor or ask here.


Vomiting is a so-called retro-peristalsis. Normally, the peristalsis propels the food from the mouth towards the anus. If the sequence of the timely coordinated contraction of subsequent segments of the intestines is disturbed, retro-peristalsis may be a consequence. In such a situation deeper segments of the intestines may contract not after the contraction of the upper parts but simultaneously. This builds up an enormous pressure inside the upper parts of the intestines which flushes back food towards the stomach, the esophagus and finally to the mouth-vomiting occurs.

The forward transport may become disturbed due to mechanical or intrinsically muscular or neural disorders of the stomach and the upper intestines.

A very important mechanical obstacle is the compression of the duodenum by the aorta which pushes the horizontal part of the duodenum against the superior mesenteric artery. This disorder is known as Wilkie syndrome and may be corrected by an operation.


The peristalsis is the motor function of the bowel and stomach. It needs to be slow enough to give the bowel time to absorb nutrients and it needs to be fast enough to transport digested food towards the anus. If the peristalsis is too slow, the stomach remains full, often many hours after a meal and dilates progressively. Sometimes such a development is described as gastroparesis. The stomach enlarges and not rarely extends down into the pelvis.


One example for a disturbed innervation of stomach and duodenum is the median arcuate ligament syndrome. The pressure of the arcuate ligament onto the nervous plexus surrounding the coeliac artery, the coeliac plexus aka solar plexus, disturbs the normal activity of this important vegetative nervous network. The normal function of the coeliac plexus consists among others to orchestrate the timely action of food uptake, secretion of digestive fluids and enzymes and a useful, propulsive peristalsis.

In the median arcuate ligament syndrome aka MALS or Dunbar syndrome a weak peristalsis may occur due to the mechanical damage of the coeliac plexus. The often long-lasting pressure of the ligament onto the nervous plexus produces an irritation in its beginning and a loss of function due to scarring after years of persisting pressure. Thus, diarrhoea may occur in early phases as a sign of irritation with an accelerated peristalsis. Later due to scarring a slow or lacking peristalsis may become the leading complaint. This is felt as bloating and constipation.

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