Mallory–Weiss syndrome or gastro-esophageal laceration syndrome refers to bleeding from a laceration in the
mucosa at the junction of the
stomach and
esophagus.[1] This is usually caused by severe
vomiting because of
alcoholism or
bulimia,[2] but can be caused by any condition which causes violent vomiting and retching such as food poisoning. The syndrome presents with
hematemesis. The laceration is sometimes referred to as a Mallory–Weiss tear.
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[3] 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.[4] 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).[5] 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.[6][7]Hyperemesis gravidarum, which is severe morning sickness associated with vomiting and retching in pregnancy, is also a known cause of Mallory–Weiss tear.[8]
Treatment is usually supportive as persistent bleeding is uncommon. However
cauterization or injection of
epinephrine[13] 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.
^Sattar, Husain A. (2011). Fundamentals of Pathology. Pathoma, LLC.
ISBN9780983224600.
^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 Italian). 35 (1): 7–12.
PMID2657497.
^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.
PMID2287873.
^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.
PMID19772708.
^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.
PMID7304810.