- Moises Guelrud, MD
Moises Guelrud, MD
- Clinical Professor of Medicine
- Tufts University School of Medicine
Mallory-Weiss syndrome is characterized by longitudinal mucosal lacerations (intramural dissection) in the distal esophagus and proximal stomach, which are usually associated with forceful retching . The lacerations often lead to bleeding from submucosal arteries. This topic will review the epidemiology, pathogenesis, clinical manifestations, diagnosis, and management of Mallory-Weiss syndrome. The management of other causes of upper gastrointestinal bleeding and esophageal perforation are discussed in detail, separately. (See "Causes of upper gastrointestinal bleeding in adults" and "Boerhaave syndrome: Effort rupture of the esophagus".)
The reported incidence of Mallory-Weiss syndrome among patients presenting with upper gastrointestinal bleeding ranges from 8 to 15 percent [2-4]. It is likely that Mallory-Weiss syndrome occurs in a less severe form more frequently than is recognized. However, the incidence of Mallory-Weiss tear in patients without overt gastrointestinal bleeding is not well established [5,6].
ETIOLOGY AND PATHOGENESIS
The pathogenesis of Mallory-Weiss syndrome is not completely understood. It has been proposed that mucosal lacerations develop secondary to a sudden increase in intraabdominal pressure. Bleeding occurs when the tear involves the underlying esophageal venous or arterial plexus. Observational studies have identified certain clinical and demographic features as potential risk factors, although these are not all consistently found in all studies [4,7-15].
●Alcohol use— A history of heavy alcohol use leading to vomiting has been noted in 40 to 80 percent of patients with Mallory-Weiss syndrome in case series [4,8-11]. The bleeding is usually more severe when Mallory-Weiss tears are associated with portal hypertension and esophageal varices [12,13].
●Hiatal hernia — It is unclear if hiatal hernia is a risk factor for Mallory-Weiss syndrome. It has been proposed that retching increases the potential for mucosal laceration by creating a higher pressure gradient in the hiatus hernia as compared with the rest of the stomach. Although a hiatus hernia has been reported in 40 to 80 percent of patients with Mallory-Weiss tears in some case series, a large case-control study found no significant difference in the prevalence of hiatus hernia among patients with Mallory-Weiss syndrome and controls [8,14]. (See "Hiatus hernia".)
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- ETIOLOGY AND PATHOGENESIS
- CLINICAL MANIFESTATIONS
- Upper endoscopy
- DIFFERENTIAL DIAGNOSIS
- INITIAL MANAGEMENT
- Inpatient versus outpatient management
- Pharmacologic therapy for all patients
- - Acid suppression
- - Antiemetics
- Endoscopic therapy for patients with active bleeding
- TREATMENT OF PERSISTENT AND RECURRENT BLEEDING
- RESUMPTION OF ANTICOAGULANTS AND ANTIPLATELET AGENTS
- SUMMARY AND RECOMMENDATIONS