Mallory-Weiss syndrome overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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
Complications
Prognosis
Diagnosis
History 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 and rarely the condition is fatal.
Physical Examination
Laboratory Findings
Imaging Findings
Other Diagnostic Studies
Definitive diagnosis is by endoscopy.
Treatment
Medical Therapy
Treatment is usually supportive as persistent bleeding is uncommon. However cauterization or injection of epinephrine[2] 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. It is to be noted that the 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.
Surgery
Surgical oversewing of the tear is reserved for the occasional bleeding case that is refractory to endoscopic therapy or angiotherapy.
Prevention
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.
- ↑ Gawrieh S, Shaker R (2005). "Treatment of actively bleeding Mallory-Weiss syndrome: epinephrine injection or band ligation?". Current gastroenterology reports. 7 (3): 175. PMID 15913474.