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Mallory–Weiss syndrome

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Mallory–Weiss syndrome
Other names: Gastro-esophageal laceration syndrome; Mallory–Weiss tear
Mallory–Weiss tear affecting the esophageal side of the gastroesophageal junction
SpecialtyGastroenterology
SymptomsVomiting of blood[1]
CausesVomiting,retching, trauma to the abdomen or chest, coughing, hiccups[2]
Risk factorsAlcohol, hiatus hernia[2]
Differential diagnosisPeptic ulcer disease, varices, erosive gastritis, duodenitis, esophagitis, cancer, angiodysplasia, Dieulafoy's lesion[1][3]
TreatmentIntravenous fluids, blood products, endoscopic procedures, surgery[2][4]
MedicationProton pump inhibitor, medication for nausea[2]
PrognosisUsually good[4]
Frequency7 per 100,000 per yr[3]
Deaths5% risk at a month[2]
Named afterG. Kenneth Mallory, Soma Weiss[2]

Mallory–Weiss syndrome (MWS), also known as gastro-esophageal laceration syndrome, is a tear in the mucosa at the junction of the stomach and esophagus.[1] It may present with vomiting of blood.[1] The blood can be either red or black in color.[2] Upper abdominal pain or black stool may be present.[2]

It usually occurs as a result of vomiting or retching and is frequently associated with drinking alcohol.[1][2] Other causes may include trauma to the abdomen or chest, coughing, and hiccups.[2] Risk factors possibly include a hiatus hernia.[2] Diagnosis is confirmed by upper endoscopy.[2] It is one of the causes of upper gastrointestinal bleeding.[2] It differs from Boerhaave syndrome, which is a break in the full thickness of the esophagus.[5]

Initial management may include intravenous fluids, including blood products.[2] A proton pump inhibitor and medication for nausea may be given.[2] A nasogastric tube may help monitor blood loss.[2] Often the bleeding will resolve without specific measures; though, if ongoing bleeding is found during endoscopy a number of procedures may be carried out.[2][4] Surgery or embolization is rarely required.[1][4] The risk of death in the subsequent month is about 5%.[2]

Mallory–Weiss syndrome occurs in about 7 per 100,000 people a year.[3] It represents about 10% of upper gastrointestinal bleeding cases.[1][4] Males are more commonly affected than females.[2] It occurs most frequently in those who are in their 40s and 50s.[2] It was first described by G. Kenneth Mallory and Soma Weiss in 1929.[2]

Signs and symptoms

Mallory–Weiss Syndrome often presents as an episode of vomiting up blood (hematemesis) after violent retching or vomiting, but may also be noticed as old blood in the stool (melena), and a history of retching may be absent.

In most cases, the bleeding stops spontaneously after 24–48 hours, but endoscopic or surgical treatment is sometimes required. The condition is rarely fatal.[citation needed]

Causes

It is often associated with alcoholism[6] and eating disorders and there is some evidence that presence of a hiatal hernia is a predisposing condition. Forceful vomiting causes tearing of the mucosa at the junction. NSAID abuse is also a rare association.[7] In rare instances some chronic disorders like Ménière's disease that cause long term nausea and vomiting could be a factor.

The tear involves the mucosa and submucosa but not the muscular layer (contrast to Boerhaave syndrome which involves all the layers).[8] Most patients are between the ages of 30 and 50 years, although it has been reported in infants aged as young as 3 weeks, as well as in older people [9][10] Hyperemesis gravidarum, which is severe morning sickness associated with vomiting and retching in pregnancy, is also a known cause of Mallory–Weiss tear.[11]

Diagnosis

1.5-cm mucosal laceration in descending portion of duodenum arrow

Definitive diagnosis is by endoscopy.[12] Proper history taking by the medical doctor to distinguish other conditions that cause haematemesis but definitive diagnosis is by conducting esophagogastroduodenoscopy.[13][14][15]

Treatment

Treatment is usually supportive as persistent bleeding is uncommon. However cauterization or injection of epinephrine[16] to stop the bleeding may be undertaken during the index endoscopy procedure. Very rarely embolization of the arteries supplying the region may be required to stop the bleeding. If all other methods fail, high gastrostomy can be used to ligate the bleeding vessel. A Blakemore tube will not be able to stop bleeding as here the bleeding is arterial and the pressure in the balloon is not sufficient to overcome the arterial pressure.

Esophageal balloon tamponade may occationally be carried out as a temporary measure.[4]

History

The condition was first described in 1929 by G. Kenneth Mallory and Soma Weiss in 15 alcoholic patients.[17]

See also

  • Boerhaave syndrome – Full thickness esophageal ruptures are also often secondary to vomiting/retching.

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Samuel, R; Bilal, M; Tayyem, O; Guturu, P (July 2018). "Evaluation and management of Non-variceal upper gastrointestinal bleeding". Disease-a-month : DM. 64 (7): 333–343. doi:10.1016/j.disamonth.2018.02.003. PMID 29525375.
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 Rich, K (June 2018). "Overview of Mallory-Weiss syndrome". Journal of vascular nursing : official publication of the Society for Peripheral Vascular Nursing. 36 (2): 91–93. doi:10.1016/j.jvn.2018.04.001. PMID 29747789.
  3. ↑ 3.0 3.1 3.2 Wilkins, T; Wheeler, B; Carpenter, M (1 March 2020). "Upper Gastrointestinal Bleeding in Adults: Evaluation and Management". American family physician. 101 (5): 294–300. PMID 32109037.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Rawla, P; Devasahayam, J (January 2025). "Mallory-Weiss Syndrome". StatPearls. PMID 30855778.
  5. ↑ Turner, AR; Collier, SA; Turner, SD (January 2025). "Boerhaave Syndrome". StatPearls. PMID 28613559.
  6. ↑ Caroli A, Follador R, Gobbi V, Breda P, Ricci G (1989). "[Mallory–Weiss syndrome. Personal experience and review of the literature]". Minerva Dietologica e Gastroenterologica (in italiano). 35 (1): 7–12. PMID 2657497.
  7. ↑ R, Eslava García; Jl, Negrete Pardo; P, Muñoz Kim; S, García (April 1990). "[Mallory–Weiss Syndrome. Surgical Treatment After Sclerotherapy. Presentation of a Case and Review of the Literature]". Revista de Gastroenterologia de Mexico. 55 (2): 75–7. PMID 2287873.
  8. ↑ Boerhaave Syndrome at eMedicine
  9. ↑ Ba¸k-Romaniszyn, L.; Małecka-Panas, E.; Czkwianianc, E.; Płaneta-Małecka, I. (1999-03-01). "Mallory–Weiss syndrome in children". Diseases of the Esophagus. 12 (1): 65–67. doi:10.1046/j.1442-2050.1999.00006.x. ISSN 1120-8694. PMID 10941865. Archived from the original on 2022-01-11. Retrieved 2021-10-06. Archived 2022-01-11 at the Wayback Machine
  10. ↑ Kitagawa, Takashi; Takano, Hideya; Sohma, Mitsuhiro; Mutoh, Eiji; Takeda, Shouzo (1994). "Clinical Study of Mallory–Weiss Syndrome in the Aged Patients Over 75 Year. Mainly Five Cases Induced by the Endoscopic Examination". Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics. 31 (5): 374–379. doi:10.3143/geriatrics.31.374. ISSN 0300-9173. PMID 8072208.
  11. ↑ Parva M, Finnegan M, Keiter C, Mercogliano G, Perez CM (August 2009). "Mallory–Weiss tear diagnosed in the immediate postpartum period: a case report". J Obstet Gynaecol Can. 31 (8): 740–3. doi:10.1016/S1701-2163(16)34280-3. PMID 19772708.
  12. ↑ Hastings, Paul R.; Peters, Kenneth W.; Cohn, Isidore (November 1981). "Mallory–Weiss syndrome". The American Journal of Surgery. 142 (5): 560–562. doi:10.1016/0002-9610(81)90425-6. PMID 7304810.
  13. ↑ "Gastroscopy – examination of oesophagus and stomach by endoscope". BUPA. December 2006. Archived from the original on 2007-10-06. Retrieved 2007-10-07. Archived 2007-10-06 at the Wayback Machine
  14. ↑ National Digestive Diseases Information Clearinghouse (November 2004). "Upper Endoscopy". National Institutes of Health. Archived from the original on 2007-10-24. Retrieved 2007-10-07. Archived 2007-10-24 at the Wayback Machine
  15. ↑ "What is Upper GI Endoscopy?". Patient Center -- Procedures. American Gastroenterological Association. Archived from the original on 2007-09-28. Retrieved 2007-10-07. Archived 2007-09-28 at the Wayback Machine
  16. ↑ Gawrieh S, Shaker R (2005). "Treatment of actively bleeding Mallory–Weiss syndrome: epinephrine injection or band ligation?". Current Gastroenterology Reports. 7 (3): 175. doi:10.1007/s11894-005-0030-0. PMID 15913474. S2CID 195343875.
  17. ↑ Weiss S, Mallory GK (1932). "Lesions of the cardiac orifice of the stomach produced by vomiting". Journal of the American Medical Association. 98 (16): 1353–5. doi:10.1001/jama.1932.02730420011005.

External links

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External resources


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