The tear can be caused by forceful vomiting.
Symptoms include blood in vomit.
The diagnosis is based on upper endoscopy.
When needed, treatment includes measures to stop the bleeding.
The esophagus Throat and Esophagus The throat (pharynx—see also Throat) lies behind and below the mouth. When food and fluids leave the mouth, they pass through the throat. Swallowing of food and fluids begins voluntarily and... read more is the hollow tube that leads from the throat (pharynx) to the stomach. (See also Overview of the Esophagus Overview of the Esophagus The esophagus is the hollow tube that leads from the throat (pharynx) to the stomach. Food does not just fall through the esophagus into the stomach. The walls of the esophagus propel food to... read more and Overview of Esophageal Injuries Overview of Esophageal Injuries The esophagus (the hollow tube that leads from the throat to the stomach) is rather difficult to injure but it can be injured gradually by backflow of acid from the stomach (gastroesophageal... read more .)
A laceration of the lower esophagus and the upper part of the stomach during forceful vomiting, retching, or hiccups is called a Mallory-Weiss tear. The tear may rupture blood vessels, which then bleed. Mallory-Weiss syndrome was initially described in people with an alcohol use disorder, but it can occur in anyone who vomits forcefully.
Mallory-Weiss syndrome is the cause of about 5% of bleeding episodes in the upper digestive tract (see also Gastrointestinal Bleeding Gastrointestinal Bleeding Bleeding may occur anywhere along the digestive (gastrointestinal [GI]) tract, from the mouth to the anus. Blood may be easily seen by the naked eye (overt), or blood may be present in amounts... read more ).
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Symptoms of Esophageal Laceration
The first symptom of Mallory-Weiss syndrome is usually the appearance of bright-red blood in vomit. Vomiting blood is called hematemesis. Some people feel sharp pain in the lower chest when the esophagus tears during vomiting.
Diagnosis of Esophageal Laceration
Doctors suspect the diagnosis of Mallory-Weiss syndrome in people who have blood in their vomit after one or more episodes of vomiting. If the amount of bleeding is small, doctors may wait to do testing because the bleeding may stop on its own.
If the bleeding is severe or does not stop on its own, doctors do upper endoscopy. During upper endoscopy, doctors examine the esophagus using a flexible tube called an endoscope Endoscopy Endoscopy is an examination of internal structures using a flexible viewing tube (endoscope). Endoscopy can also be used to treat many disorders because doctors are able to pass instruments... read more . Upper endoscopy allows doctors to see the bleeding source and often treat it at the same time.
If bleeding is rapid or severe, doctors sometimes do angiography. During angiography, doctors use a catheter to inject an artery with a liquid (contrast agent Radiographic Contrast Agents During imaging tests, contrast agents may be used to distinguish one tissue or structure from its surroundings or to provide greater detail. Contrast agents include Radiopaque contrast agents... read more ) that can be seen on x-rays.
Treatment of Esophageal Laceration
Measures to stop the bleeding
Most bleeding episodes stop by themselves, but sometimes the doctor must do endoscopy and take measures to stop the bleeding. Measures include using heat to cauterize the bleeding blood vessel, clipping it closed, or injecting a drug into it.
Alternatively, the doctor may inject vasopressin or epinephrine into the bleeding blood vessel during angiography to stop the bleeding.
People who lose a lot of blood require a blood transfusion Overview of Blood Transfusion A blood transfusion is the transfer of blood or a blood component from one healthy person (a donor) to a sick person (a recipient). Transfusions are given to increase the blood's ability to... read more .
Surgery to repair the tear is rarely required.
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