Mallory-Weiss Syndrome

(See also Overview of Esophageal and Swallowing Disorders Overview of Esophageal and Swallowing Disorders The swallowing apparatus consists of the pharynx, upper esophageal (cricopharyngeal) sphincter, the body of the esophagus, and the lower esophageal sphincter (LES). The upper third of the esophagus... read more .)

Initially described in patients with alcohol use disorder, Mallory-Weiss syndrome can occur in any patient who vomits forcefully. It is the cause of about 5% of episodes of upper gastrointestinal (GI) hemorrhage. The tear may also be accompanied by pain in the lower chest.

Diagnosis of Mallory-Weiss syndrome is suggested clinically by a typical history of hematemesis occurring after one or more episodes of non-bloody vomiting. In such cases, if the amount of bleeding is minimal and the patient is stable, testing may be deferred and some patients can be discharged home. Otherwise, if history is unclear or bleeding is ongoing, the patient should have standard evaluation for GI bleeding Evaluation Gastrointestinal (GI) bleeding can originate anywhere from the mouth to the anus and can be overt or occult. The manifestations depend on the location and rate of bleeding. (See also Varices... read more , typically with upper endoscopy and laboratory testing. Upper endoscopy can also be therapeutic because a clip can be placed over the tear to control bleeding.

Most episodes of bleeding stop spontaneously; severe bleeding occurs in about 10% of patients, who require significant intervention, such as transfusion or endoscopic hemostasis (by clip placement, injection of ethanol or epinephrine, or by electrocautery). Intra-arterial infusion of vasopressin or therapeutic embolization into the left gastric artery during angiography may also be used to control bleeding. Surgical repair is rarely required.