Sclerosing mesenteritis is a rare abdominal condition. Discover the 2025 American Gastroenterological Association (AGA) guidelines and how Bumrungrad provides expert diagnosis, advanced imaging, and personalized care.
—the fatty tissue that anchors your intestines inside your abdomen. This condition involves three main features:
Thanks to improved medical imaging—especially
CT scans (computed tomography)—SM is being diagnosed more frequently, sometimes even in people with no symptoms.
In March 2025, the
American Gastroenterological Association (AGA) released new, patient-friendly clinical guidelines to help people understand and manage SM. This guide breaks down those recommendations in plain language, so patients and caregivers can feel empowered and informed.
Symptoms: Often Silent, Sometimes Severe
Most people with SM don’t feel anything unusual. But when symptoms do appear, they may include:
- Abdominal pain (common—up to 75% of symptomatic patients)
- Digestive issues such as bloating, diarrhea, or constipation (10–25%)
- Nausea or vomiting (5–15%)
- Unexplained weight loss (20%)
SM can be associated with
metabolic syndrome (a group of conditions like high blood pressure and high blood sugar),
obesity, and
heart disease. Autoimmune conditions (where the body attacks itself) are not typically linked.
How Is It Diagnosed? CT Scans Are Key
Doctors usually diagnose SM using a
CT scan, which provides a detailed image of your abdomen. To confirm SM, radiologists look for five key signs—called
Coulier’s criteria:
- Cloudy-looking fat that pushes nearby intestines
- Higher fat density compared to nearby tissues (without using dye)
- Small lymph nodes (less than 1 cm in size) in the mesentery
- A pale halo around blood vessels
- A thin capsule-like border around the inflamed area
If
three or more of these signs appear, SM is strongly suspected. In most cases, a
biopsy (tissue sample) is not needed unless cancer is suspected.
.png "CT")
When to Be Concerned: Red Flags and Severe Forms
Some patients may develop more serious symptoms or complications:
- Spread beyond the mesentery, such as to the omentum (another fat layer) or retroperitoneum (back part of the abdomen)
- Bowel blockages, blood clots, kidney problems, or protein loss
- Elevated inflammation markers in blood tests, such as:
- CRP (C-reactive protein)
- ESR (erythrocyte sedimentation rate)
- Presence of IgG4-related disease, a condition that causes immune-related tissue inflammation
Doctors may use
PET scans (positron emission tomography) to assess how active the inflammation is. A
biopsy is recommended when:
- Lymph nodes are larger than 1 cm
- The SUVmax (standardized uptake value maximum) is 3.0 or higher on a PET scan—indicating high activity
- CT images look abnormal or suspicious
- There's concern about IgG4 disease—a rare autoimmune condition that requires special staining
What Else Could It Be? Similar Conditions to Rule Out
To ensure an accurate diagnosis, doctors consider other diseases that can look like SM:
- Lymphoma – a cancer of lymph nodes, often showing up as large abdominal nodes
- Carcinomatosis – widespread cancer in the abdomen, usually with fluid buildup
- Carcinoid tumors – rare tumors that can occur in the intestines or mesentery
- Desmoid tumors – non-cancerous but aggressive growths that wrap around blood vessels
- Encapsulating peritoneal sclerosis – a thick layer forms around intestines
- Retroperitoneal fibrosis – scar tissue in the back abdomen that can block urine flow
- Pseudomyxoma peritonei – jelly-like tumor material that coats abdominal organs
Is SM Related to Cancer?
No, sclerosing mesenteritis is not a cancer and does not turn into cancer. But it can be mistaken for cancer on scans. In rare cases, SM is found alongside cancer. A major study found the risk of developing cancer later was only about 1%.
Doctors pay special attention if there’s:
- A mass larger than 10 mm
- Unusual or enlarged lymph nodes
In such cases,
PET scans and biopsies are used to rule out malignancy.
Blood Tests and IgG4 Disease: More Clues
Inflammation in SM may show up in routine blood tests, such as:
- CRP (C-reactive protein) – rises when there’s inflammation
- ESR (erythrocyte sedimentation rate) – another general inflammation marker
In rare cases, SM overlaps with
IgG4-related disease, an immune condition that mimics cancer. Diagnosing this type requires
special biopsy testing for IgG4.
Treatment: When Is It Needed?
Not everyone with SM needs treatment. It depends on the symptoms:
- No symptoms: No treatment needed. Doctors monitor with annual CT scans for 2 years
- Mild symptoms: Anti-inflammatory medicines like steroids or tamoxifen may help
- Severe cases: May require immune-suppressing drugs and close follow-up
Biopsies help guide treatment, especially when scans show unusual features or when IgG4-related disease is suspected.
Why Choose Hospital-Based Multidisciplinary Care?
At
Bumrungrad International Hospital, we offer an integrated care system for rare and complex conditions like SM. Patients benefit from:
- Advanced imaging tools: CT, MRI, PET-CT
- A team of experts, including gastroenterologists, radiologists, pathologists, oncologists, and surgeons
- Interventional radiology for precise, image-guided biopsies
- IgG4 staining for accurate diagnosis of immune-related conditions
- Personalized treatment plans
- Long-term monitoring and follow-up care
Having all these services in one place ensures faster diagnosis, better coordination, and peace of mind.
Final Thoughts: Expert Care for a Rare Disease
Sclerosing mesenteritis may be rare and mysterious, but it doesn’t have to be overwhelming. With the
2025 AGA guidelines, expert medical teams, and cutting-edge technology, patients can face this condition with confidence.
At Bumrungrad, we are proud to offer
comprehensive care—from diagnosis to long-term support—under one roof.
Looking for answers or a second opinion?
Schedule a consultation with our
Digestive Disease Center today. Compassionate, coordinated care is just one step away.
Tossapol Kerdsirichairat, MD, FACG, FASGE
Clinical Associate Professor of Medicine
Advanced/Bariatric Endoscopy, Digestive Disease Center
Bumrungrad International Hospital