Mallory-Weiss syndrome overview
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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 refers to bleeding from tears in the mucosa at the junction of the stomach and esophagus, usually caused by severe retching, coughing, or vomiting. It is often associated with alcoholism and eating disorders and there is some evidence that presence of a hiatal hernia is a required predisposing condition.
Historical Perspective
In 1929 G. Kenneth Mallory, pathologist (1900-86) and Soma Weiss, physician (1898-1942), first described Mallory-Weiss syndrome. [1].
Classification
There is no established system for the classification of Mallory-Weiss syndrome.
Pathophysiology
It is thought that Mallory-Weiss syndrome is the result of sudden increase in intraabdominal pressure that causes mucosal lacerations. If the tear involves the esophageal venous or arterial Plexus,bleeding occurs.
Causes
Mallory-Weiss syndrome is caused by severe retching, coughing, or vomiting. It is often associated with alcoholism and eating disorders and there is some evidence that presence of a hiatal hernia is a required predisposing condition.
Differentiating Mallory-Weiss syndrome overview from Other Diseases
Mallory-Weiss syndrome must be differentiated from other causes of Upper gastrointestinal bleeding such as PUD, Esophagogastric varices, Severe or erosive gastritis/duodenitis, Angiodysplasia.
Epidemiology and Demographics
Mallory-Weiss syndrome is suggested to be associated with increased age. The incidence of Mallory-Weiss syndrome is 4 per 100,000 individuals. The incidence of Mallory-Weiss syndrome in patients with Upper gastrointestinal bleeding is from 8% to 15%.
Risk Factors
The most potent risk factors in the development of Mallory-Weiss syndrome are Alcohol use and Hiatal hernia. The less potent risk factor in the development of Mallory-Weiss syndrome is age.
Screening
There is insufficient evidence to recommend routine screening for Mallory-Weiss syndrome.
Natural History, Complications, and Prognosis
Natural History
Mallory-Weiss tears heal quickly in the absence of portal hypertensive.
Complications
Hemorrhage, organ ischemia and infarction.
Prognosis
Repeated bleeding is uncommon and the outcome is usually good. Cirrhosis of the liver and problems with blood clotting make future bleeding episodes more likely to occur.
Diagnosis
History and Symptoms
The hallmark of Mallory-Weiss syndrome is acute onset of bloody vomiting. A positive history of forceful vomiting and retching are suggestive of Mallory-Weiss syndrome, but may present as an old blood in the stool with no history of retching.
Physical Examination
Mallory-Weiss syndrome is usually associated with tachycardia, weak pulse and hypotension.
Laboratory Findings
Blood tests, such as a complete blood count (CBC), blood chemistries, blood clotting tests, and liver function tests, are used to assess the condition of the patient.
BUN, creatinine, and electrolyte levels are measured to guide intravenous fluid therapy.
Imaging Findings
If there is mucosal laceration without perforation, it is likely to be occult on CT scan. However, CT may show evidence of hemorrhage or extraluminal gas at the tear site.
Other Diagnostic Studies
Upper endoscopy is the definitive diagnostic study for Mallory-Weiss Syndrome. Tears are located in the esophagogastric junction. The tear usually extends into the cardia and sometimes into the esophagus.
Treatment
Medical Therapy
Treatment of Mallory-Weiss syndrome is usually supportive because persistent bleeding is uncommon. Injection of epinephrine or cauterization may be done to stop bleeding during endoscopy.
Surgery
Surgical oversewing of the tear is reserved for those who fail angiographic therapy.
Prevention
Treatments to relieve vomiting and coughing may reduce risk. Avoidance of excessive alcohol use.
References
- ↑ Weiss S, Mallory GK. Lesions of the cardiac orifice of the stomach produced by vomiting. Journal of the American Medical Association 1932;98:1353-55.