MALLORY-WEISS SYNDROME

• A Mallory -Weiss tear (MWT) is forceful or retching vomiting may produce a longitudinal mucosal tear immediately below squamo columnar junction at the cardia or gastroesophageal junction mainly and also in oesophagus.
• Seen in males, alcholics and pregnant females.
• Superficial Mallory- Weiss tear starts healing with hours and can complete within 48 hours.

ETIOLOGY:

• Alcoholism
• Hiatal hernia 
• 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.

DIAGNOSIS- 

• EGD
• Best diagnosed by contrast radiology.
• For persistent bleeding- endoscopic ectrocoagulation
• 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
• Blood transfusion, if there is excessive bleeding.
• Bleeding is treated with epinephrine injection and during endoscopy hemaclips can be placed.
• If excessive bleeding occurs, shock symptoms may occur and require prompt interventions