Mallory-Weiss Syndrome

DEFINITION:

• A Mallory -Weiss tear (MWT) is a longitudinal tear in the mucous membrane of the esophagus at the stomach junction (Gastric cardia).

ETIOLOGY:

• Alcoholism
• Eating disorders 
• Hiatal hernia 
• Forceful vomiting causes tearing of the mucosa at the junction. 
• NSAID abuse 
• The tear involves the mucosa and submucosa but not the muscular layer (contrast to Boerhaave syndrome which involves all the layers).
• The mean age is more than 60 and 80% are men.
• Hyperemesis gravidarum, which is severe morning sickness associated with vomiting and retching in pregnancy, is also a known cause of Mallory-Weiss tear

CLINICAL PRESENTATION:

• Episode of vomiting up blood (hematemesis) after violent retching or vomiting
• Old blood in the stool (melena), and a history of retching may be absent.
• In Mallory-Weiss syndrome the majority (75-90%) of tear is located below the gastroesophageal junction, entirely within the gastric cardia.
• Only a few of the tears involve the gastro-esophageal junction.
• In most cases, the bleeding stops spontaneously after 24–48 hours, but endoscopic or surgical treatment is sometimes required and the condition is rarely fatal.

DIAGNOSIS:

• EGD
• Hemoglobin and hematocrit values are checked to determine amount of bleeding.

TREATMENT:

• Tears usually self heal without any intervention in several days and bleeding stops within a few hours.
• Medications such as a PPI and an antiemetic
• Avoid alcohol use.
• Blood transfusion, if there is excessive bleeding.
• Bleeding is treated with epinephrine injection and during endoscopy hemaclips can be placed.
• Monitor for the signs of bleeding and to report them to prevent complications from hemorrhage.
• If excessive bleeding occurs, shock symptoms may occur and require prompt interventions
• Teach about medications and avoidance of alcohol use.