Mallory-Weiss syndrome
Overview
Mallory-Weiss syndrome refers to bleeding from tears (a Mallory-Weiss tear) in the mucosa at the junction of the stomach and esophagus, usually caused by severe retching, coughing, or vomiting.
Symptoms
* Esophageal bleeding * Vomiting * Severe retching * Vomiting blood * Melena
Causes
Mallory-Weiss tears do not happen very often. They are usually caused by forceful or long-term vomiting or coughing. They may also be caused by epileptic convulsions. The tear may be followed by vomiting bright red blood or by passing blood in the stool. Any condition that leads to violent and lengthy bouts of coughing or vomiting can cause these tears.
Prevention
Treatments to relieve vomiting and coughing may reduce risk. Avoid excessive alcohol use.
Diagnosis
A Mallory-Weiss syndrome tear is not visible on standard upper gastrointestinal x rays. A tear about one-eighth to one and one-half inches long (0.5-4 cm) is revealed by endoscopy. Endoscopy also shows that in 35% of patients there is another potential cause for gastrointestinal bleeding, such as peptic ulcer, erosive gastritis, or esophageal varices.
Prognosis
Repeated bleeding is uncommon unless there is also a problem with blood clotting. The outcome is expected to be good.
Treatment
The tear usually heals in about 10 days without treatment. Surgery is rarely required. Drugs that suppress stomach acid (proton pump inhibitors or H2 blockers) may be given, but it is not clear if they are helpful. If blood loss has been great, blood transfusions may be necessary. Excessive bleeding may need to be treated by using an endoscope (see EGD). In most cases, bleeding stops without treatment within a few hours.