The pathophysiology and symptomatology of the superior mesenteric artery syndrome (SMA syndrome) is discussed. A review of much of the available literature concerning the SMA syndrome and the associated condition acute gastric dilatation is offered. Results: Two new cases of acute gastric dilatation in patients with eating disorders, one of whom was diagnosed with SMA syndrome, are presented, along with a discussion of these conditions in reference to the eating disorders. Conclusion: The SMA syndrome and gastric dilatation are rare but potentially a very serious complication of eating disorders, and clinicians who work with these patients should be aware of such problems. © 1997 by John Wiley & Sons, Inc. Int J Eat Disord 21: 103–114, 1997.