(See also Overview of Esophageal and Swallowing Disorders.)
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. Otherwise, if history is unclear or bleeding is ongoing, the patient should have standard evaluation for GI bleeding, 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.