Mallory-Weiss syndrome differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamed Diab, MD [2]

Overview

Mallory-Weiss syndrome must be differentiated from other causes of Upper gastrointestinal bleeding such as PUD, Esophagogastric varices, Severe or erosive gastritis/duodenitis, Angiodysplasia.

Differential Diagnosis

Mallory-Weiss syndrome must be differentiated from other diseases that cause esophageal ulcers such as:[1]

Diseases History and Symptoms Physical Examination Laboratory Findings Upper endoscopy
Hematemesis Epigastric pain Light-headedness Retching Heartburn History of medication Vomiting History of alcoholism Tachycardia Skin Pallor Hypotension Weak pulse Hemoglobin Platelets BUN
Mallory-Weiss syndrome + + + (with heavy bleeding) + - - + + + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) Tears are usually single and located in the esophagogastric junction, usually extends into the cardia and sometimes into the esophagus
Infectious esophagitis - + - - - - - - - - - - Ulcerations are multiple and usually involve the proximal esophagus
Medication-induced esophagitis - + - - - + - - - - - - Ulcerations are usually singular and deep
Reflux esophagitis - + - - + - - - - - - - Ulcerations are usually in distal esophagus, and maybe irregular and multiple

Mallory-Weiss syndrome must be differentiated from other causes of Upper gastrointestinal bleeding:[2][3][4][5]

Diseases History and Symptoms Physical Examination Laboratory Findings Upper endoscopy
Hematemesis Epigastric pain Retching History of alcoholism Light-headedness history of cirrhosis NSAIDs use Helicobacter pylori infection Tachycardia Hypotension Skin Pallor Weak pulse CBC Platelets BUN
Mallory-Weiss syndrome + + + + + - - - + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) <math>\downarrow</math> <math>\downarrow</math> <math>\uparrow</math> Tears are usually single and located in the esophagogastric junction, usually extends into the cardia and sometimes into the esophagus
PUD +/- + - +/- - - + + + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) <math>\downarrow</math> <math>\downarrow</math> <math>\uparrow</math> Discrete mucosal lesions with a punched-out smooth ulcer base with whitish fibrinoid base
Esophagogastric varices + + +/- + + - - + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) <math>\downarrow</math> <math>\downarrow</math> <math>\uparrow</math> The varices may be in the esophagus and/or the stomach.
Severe or erosive gastritis/duodenitis + + +/- - - +/- - + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) <math>\downarrow</math> <math>\downarrow</math> <math>\uparrow</math> Erythema, mucosal erosions, the absence of rugal folds, and visible vessels
Angiodysplasia + + - - +/- - - - + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) <math>\downarrow</math> <math>\downarrow</math> <math>\uparrow</math> small, flat, cherry-red lesions with a fern-like pattern

References

  1. Sutton FM, Graham DY, Goodgame RW (1994). "Infectious esophagitis". Gastrointest. Endosc. Clin. N. Am. 4 (4): 713–29. PMID 7812643.
  2. Boonpongmanee S, Fleischer DE, Pezzullo JC, Collier K, Mayoral W, Al-Kawas F, Chutkan R, Lewis JH, Tio TL, Benjamin SB (2004). "The frequency of peptic ulcer as a cause of upper-GI bleeding is exaggerated". Gastrointest. Endosc. 59 (7): 788–94. PMID 15173790.
  3. Enestvedt BK, Gralnek IM, Mattek N, Lieberman DA, Eisen G (2008). "An evaluation of endoscopic indications and findings related to nonvariceal upper-GI hemorrhage in a large multicenter consortium". Gastrointest. Endosc. 67 (3): 422–9. doi:10.1016/j.gie.2007.09.024. PMID 18206878.
  4. Balderas V, Bhore R, Lara LF, Spesivtseva J, Rockey DC (2011). "The hematocrit level in upper gastrointestinal hemorrhage: safety of endoscopy and outcomes". Am. J. Med. 124 (10): 970–6. doi:10.1016/j.amjmed.2011.04.032. PMID 21962318.
  5. Wollenman CS, Chason R, Reisch JS, Rockey DC (2014). "Impact of ethnicity in upper gastrointestinal hemorrhage". J. Clin. Gastroenterol. 48 (4): 343–50. doi:10.1097/MCG.0000000000000025. PMC 4157370. PMID 24275716.


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