Mallory-Weiss tear, also known as Mallory-Weiss syndrome, refers to a condition characterized by a tear or laceration in the lining of the lower part of the esophagus or upper part of the stomach. It is typically caused by severe or prolonged vomiting or retching, which exerts excessive pressure on the gastroesophageal junction.
Mallory-Weiss tears commonly cause upper gastrointestinal bleeding, accounting for approximately 5-15% of cases. The tears usually occur longitudinally and are often located along the junction between the esophagus and stomach. While most Mallory-Weiss tears are superficial and heal on their own, in some cases, they can be deep and lead to significant bleeding.
Epidemiology
Mallory-Weiss tears are relatively common and account for a significant proportion of cases of upper gastrointestinal bleeding. The exact incidence and prevalence of Mallory-Weiss tears are difficult to determine precisely due to variations in study methodologies and populations. However, epidemiological studies have provided some insights into the occurrence of this condition.
Mallory-Weiss tears are more commonly observed in adults, with a peak incidence in the age group of 30 to 60. The condition affects both men and women, although some studies have suggested a slightly higher prevalence in males.
Alcohol consumption is a major risk factor for the development of Mallory-Weiss tears. Excessive alcohol intake, especially in the context of binge drinking, increases the likelihood of vomiting and retching, leading to increased pressure on the gastroesophageal junction and subsequent tears.
Anatomy
Pathophysiology
The pathophysiology of Mallory-Weiss tear involves the development of a laceration or tear in the lining of the lower part of the esophagus or upper part of the stomach, typically at the gastroesophageal junction. The tear occurs due to increased pressure and shear forces exerted on the mucosa during severe or prolonged vomiting or retching episodes. Forceful vomiting, retching, or coughing can generate significant pressure in the stomach and thoracic cavity.
This increased pressure is transmitted to the gastroesophageal junction, causing a sudden rise in intraluminal pressure within the esophagus. The increased pressure can lead to mechanical stress and shearing forces on the esophageal mucosa, resulting in the tear. The gastroesophageal junction is a site where the esophagus meets the stomach.
It has a transition from the relatively flexible esophageal mucosa to the more rigid gastric mucosa. Any weakness or vulnerability in this region, such as a structural weakness in the muscular layer or compromised blood supply, can make it more susceptible to injury. Factors like hiatal hernia or chronic gastric inflammation may contribute to weakening the gastroesophageal junction.
Etiology
Excessive alcohol intake is a major risk factor for Mallory-Weiss tears. Alcohol can irritate the gastric mucosa, leading to inflammation and weakening of the mucosal lining. Additionally, alcohol can impair the coordination of swallowing and esophageal peristalsis, making individuals more prone to forceful retching or vomiting.
Other mechanical factors can contribute to the development of Mallory-Weiss tears. These include conditions that increase abdominal pressure, such as severe coughing, violent hiccups, or childbirth.
In some cases, medical procedures such as endoscopy or esophageal dilatation can also lead to Mallory-Weiss tears. Certain factors may increase an individual’s susceptibility to Mallory-Weiss tears. These include advanced age, male gender (although tears can occur in both genders), and conditions that affect blood clotting or increase the fragility of blood vessels.
Genetics
Prognostic Factors
Clinical History
Clinical History
Hematemesis is the hallmark symptom of Mallory-Weiss syndrome. Individuals may suddenly experience vomiting bright red or dark red blood. The blood can vary, ranging from small streaks to significant amounts. Some individuals may experience pain or discomfort in the upper abdomen or epigastric region. The pain can be mild to moderate in intensity and may be associated with vomiting.
Many individuals with Mallory-Weiss syndrome have a preceding history of severe or prolonged vomiting, retching, or forceful coughing. They may have a recent episode of excessive alcohol consumption, or a history of conditions associated with increased abdominal pressure. In cases of significant bleeding, individuals may exhibit signs and symptoms of blood loss, such as lightheadedness, dizziness, weakness, pallor (pale skin), or low blood pressure.
They may also experience tachycardia (rapid heart rate) as a compensatory response. Individuals with Mallory-Weiss syndrome may have certain risk factors contributing to the tear’s development. These can include a history of alcohol abuse, hiatal hernia, chronic gastric inflammation, or other conditions associated with increased vulnerability of the gastroesophageal junction.
Physical Examination
Physical Examination
Individuals with significant bleeding from a Mallory-Weiss tear may appear pale or have paleness of the skin and mucous membranes. Pallor is indicative of blood loss and reduced hemoglobin levels. Low blood pressure may be detected during the physical examination in cases of severe bleeding. Hypotension can be a sign of significant blood loss and may be accompanied by other signs of hemodynamic instability.
Prolonged or significant bleeding can lead to fluid loss and dehydration. Signs of dehydration may include dry mucous membranes, decreased skin turgor, and decreased urine output. Some individuals with Mallory-Weiss tears may experience tenderness or discomfort upon palpation of the abdomen, particularly in the epigastric region. Abdominal tenderness can be a nonspecific finding and can also be associated with other conditions.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Differential Diagnoses
Esophageal Varices
Gastric Neoplasm
Peptic Ulcer
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
In the management of Mallory-Weiss syndrome, the initial focus is on stabilizing the patient’s overall condition, and a traditional approach is generally suitable for most patients. Upon admission, immediate resuscitation should be initiated for patients with active bleeding. Hemodynamic stability is assessed following the ABC protocol, which evaluates the airway, breathing, and circulation. If there is an electrolyte imbalance, appropriate correction should be administered.
To facilitate the recovery of the gastric and esophageal mucosa, H2 blockers and proton pump inhibitors (PPIs) are administered to reduce gastric acidity. Intravenous proton pump inhibitors are typically given initially to patients expected to go under endoscopic examination. Additionally, anti-emetics such as ondansetron and promethazine may be prescribed to manage nausea and vomiting.
It is important to note that Mallory-Weiss syndrome is generally self-limited, and recurrence is uncommon. Therefore, the primary objective in the initial management is to ensure the patient’s stability and provide supportive care. Further treatment options, such as endoscopic interventions, may be considered if necessary, based on the severity of bleeding or other clinical factors.
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Mallory-Weiss tear, also known as Mallory-Weiss syndrome, refers to a condition characterized by a tear or laceration in the lining of the lower part of the esophagus or upper part of the stomach. It is typically caused by severe or prolonged vomiting or retching, which exerts excessive pressure on the gastroesophageal junction.
Mallory-Weiss tears commonly cause upper gastrointestinal bleeding, accounting for approximately 5-15% of cases. The tears usually occur longitudinally and are often located along the junction between the esophagus and stomach. While most Mallory-Weiss tears are superficial and heal on their own, in some cases, they can be deep and lead to significant bleeding.
Mallory-Weiss tears are relatively common and account for a significant proportion of cases of upper gastrointestinal bleeding. The exact incidence and prevalence of Mallory-Weiss tears are difficult to determine precisely due to variations in study methodologies and populations. However, epidemiological studies have provided some insights into the occurrence of this condition.
Mallory-Weiss tears are more commonly observed in adults, with a peak incidence in the age group of 30 to 60. The condition affects both men and women, although some studies have suggested a slightly higher prevalence in males.
Alcohol consumption is a major risk factor for the development of Mallory-Weiss tears. Excessive alcohol intake, especially in the context of binge drinking, increases the likelihood of vomiting and retching, leading to increased pressure on the gastroesophageal junction and subsequent tears.
The pathophysiology of Mallory-Weiss tear involves the development of a laceration or tear in the lining of the lower part of the esophagus or upper part of the stomach, typically at the gastroesophageal junction. The tear occurs due to increased pressure and shear forces exerted on the mucosa during severe or prolonged vomiting or retching episodes. Forceful vomiting, retching, or coughing can generate significant pressure in the stomach and thoracic cavity.
This increased pressure is transmitted to the gastroesophageal junction, causing a sudden rise in intraluminal pressure within the esophagus. The increased pressure can lead to mechanical stress and shearing forces on the esophageal mucosa, resulting in the tear. The gastroesophageal junction is a site where the esophagus meets the stomach.
It has a transition from the relatively flexible esophageal mucosa to the more rigid gastric mucosa. Any weakness or vulnerability in this region, such as a structural weakness in the muscular layer or compromised blood supply, can make it more susceptible to injury. Factors like hiatal hernia or chronic gastric inflammation may contribute to weakening the gastroesophageal junction.
Excessive alcohol intake is a major risk factor for Mallory-Weiss tears. Alcohol can irritate the gastric mucosa, leading to inflammation and weakening of the mucosal lining. Additionally, alcohol can impair the coordination of swallowing and esophageal peristalsis, making individuals more prone to forceful retching or vomiting.
Other mechanical factors can contribute to the development of Mallory-Weiss tears. These include conditions that increase abdominal pressure, such as severe coughing, violent hiccups, or childbirth.
In some cases, medical procedures such as endoscopy or esophageal dilatation can also lead to Mallory-Weiss tears. Certain factors may increase an individual’s susceptibility to Mallory-Weiss tears. These include advanced age, male gender (although tears can occur in both genders), and conditions that affect blood clotting or increase the fragility of blood vessels.
Clinical History
Hematemesis is the hallmark symptom of Mallory-Weiss syndrome. Individuals may suddenly experience vomiting bright red or dark red blood. The blood can vary, ranging from small streaks to significant amounts. Some individuals may experience pain or discomfort in the upper abdomen or epigastric region. The pain can be mild to moderate in intensity and may be associated with vomiting.
Many individuals with Mallory-Weiss syndrome have a preceding history of severe or prolonged vomiting, retching, or forceful coughing. They may have a recent episode of excessive alcohol consumption, or a history of conditions associated with increased abdominal pressure. In cases of significant bleeding, individuals may exhibit signs and symptoms of blood loss, such as lightheadedness, dizziness, weakness, pallor (pale skin), or low blood pressure.
They may also experience tachycardia (rapid heart rate) as a compensatory response. Individuals with Mallory-Weiss syndrome may have certain risk factors contributing to the tear’s development. These can include a history of alcohol abuse, hiatal hernia, chronic gastric inflammation, or other conditions associated with increased vulnerability of the gastroesophageal junction.
Physical Examination
Individuals with significant bleeding from a Mallory-Weiss tear may appear pale or have paleness of the skin and mucous membranes. Pallor is indicative of blood loss and reduced hemoglobin levels. Low blood pressure may be detected during the physical examination in cases of severe bleeding. Hypotension can be a sign of significant blood loss and may be accompanied by other signs of hemodynamic instability.
Prolonged or significant bleeding can lead to fluid loss and dehydration. Signs of dehydration may include dry mucous membranes, decreased skin turgor, and decreased urine output. Some individuals with Mallory-Weiss tears may experience tenderness or discomfort upon palpation of the abdomen, particularly in the epigastric region. Abdominal tenderness can be a nonspecific finding and can also be associated with other conditions.
Differential Diagnoses
Esophageal Varices
Gastric Neoplasm
Peptic Ulcer
In the management of Mallory-Weiss syndrome, the initial focus is on stabilizing the patient’s overall condition, and a traditional approach is generally suitable for most patients. Upon admission, immediate resuscitation should be initiated for patients with active bleeding. Hemodynamic stability is assessed following the ABC protocol, which evaluates the airway, breathing, and circulation. If there is an electrolyte imbalance, appropriate correction should be administered.
To facilitate the recovery of the gastric and esophageal mucosa, H2 blockers and proton pump inhibitors (PPIs) are administered to reduce gastric acidity. Intravenous proton pump inhibitors are typically given initially to patients expected to go under endoscopic examination. Additionally, anti-emetics such as ondansetron and promethazine may be prescribed to manage nausea and vomiting.
It is important to note that Mallory-Weiss syndrome is generally self-limited, and recurrence is uncommon. Therefore, the primary objective in the initial management is to ensure the patient’s stability and provide supportive care. Further treatment options, such as endoscopic interventions, may be considered if necessary, based on the severity of bleeding or other clinical factors.
medtigo
Mallory-Weiss Tear
Updated :
August 22, 2023
Mallory-Weiss tear, also known as Mallory-Weiss syndrome, refers to a condition characterized by a tear or laceration in the lining of the lower part of the esophagus or upper part of the stomach. It is typically caused by severe or prolonged vomiting or retching, which exerts excessive pressure on the gastroesophageal junction.
Mallory-Weiss tears commonly cause upper gastrointestinal bleeding, accounting for approximately 5-15% of cases. The tears usually occur longitudinally and are often located along the junction between the esophagus and stomach. While most Mallory-Weiss tears are superficial and heal on their own, in some cases, they can be deep and lead to significant bleeding.
Mallory-Weiss tears are relatively common and account for a significant proportion of cases of upper gastrointestinal bleeding. The exact incidence and prevalence of Mallory-Weiss tears are difficult to determine precisely due to variations in study methodologies and populations. However, epidemiological studies have provided some insights into the occurrence of this condition.
Mallory-Weiss tears are more commonly observed in adults, with a peak incidence in the age group of 30 to 60. The condition affects both men and women, although some studies have suggested a slightly higher prevalence in males.
Alcohol consumption is a major risk factor for the development of Mallory-Weiss tears. Excessive alcohol intake, especially in the context of binge drinking, increases the likelihood of vomiting and retching, leading to increased pressure on the gastroesophageal junction and subsequent tears.
The pathophysiology of Mallory-Weiss tear involves the development of a laceration or tear in the lining of the lower part of the esophagus or upper part of the stomach, typically at the gastroesophageal junction. The tear occurs due to increased pressure and shear forces exerted on the mucosa during severe or prolonged vomiting or retching episodes. Forceful vomiting, retching, or coughing can generate significant pressure in the stomach and thoracic cavity.
This increased pressure is transmitted to the gastroesophageal junction, causing a sudden rise in intraluminal pressure within the esophagus. The increased pressure can lead to mechanical stress and shearing forces on the esophageal mucosa, resulting in the tear. The gastroesophageal junction is a site where the esophagus meets the stomach.
It has a transition from the relatively flexible esophageal mucosa to the more rigid gastric mucosa. Any weakness or vulnerability in this region, such as a structural weakness in the muscular layer or compromised blood supply, can make it more susceptible to injury. Factors like hiatal hernia or chronic gastric inflammation may contribute to weakening the gastroesophageal junction.
Excessive alcohol intake is a major risk factor for Mallory-Weiss tears. Alcohol can irritate the gastric mucosa, leading to inflammation and weakening of the mucosal lining. Additionally, alcohol can impair the coordination of swallowing and esophageal peristalsis, making individuals more prone to forceful retching or vomiting.
Other mechanical factors can contribute to the development of Mallory-Weiss tears. These include conditions that increase abdominal pressure, such as severe coughing, violent hiccups, or childbirth.
In some cases, medical procedures such as endoscopy or esophageal dilatation can also lead to Mallory-Weiss tears. Certain factors may increase an individual’s susceptibility to Mallory-Weiss tears. These include advanced age, male gender (although tears can occur in both genders), and conditions that affect blood clotting or increase the fragility of blood vessels.
Clinical History
Hematemesis is the hallmark symptom of Mallory-Weiss syndrome. Individuals may suddenly experience vomiting bright red or dark red blood. The blood can vary, ranging from small streaks to significant amounts. Some individuals may experience pain or discomfort in the upper abdomen or epigastric region. The pain can be mild to moderate in intensity and may be associated with vomiting.
Many individuals with Mallory-Weiss syndrome have a preceding history of severe or prolonged vomiting, retching, or forceful coughing. They may have a recent episode of excessive alcohol consumption, or a history of conditions associated with increased abdominal pressure. In cases of significant bleeding, individuals may exhibit signs and symptoms of blood loss, such as lightheadedness, dizziness, weakness, pallor (pale skin), or low blood pressure.
They may also experience tachycardia (rapid heart rate) as a compensatory response. Individuals with Mallory-Weiss syndrome may have certain risk factors contributing to the tear’s development. These can include a history of alcohol abuse, hiatal hernia, chronic gastric inflammation, or other conditions associated with increased vulnerability of the gastroesophageal junction.
Physical Examination
Individuals with significant bleeding from a Mallory-Weiss tear may appear pale or have paleness of the skin and mucous membranes. Pallor is indicative of blood loss and reduced hemoglobin levels. Low blood pressure may be detected during the physical examination in cases of severe bleeding. Hypotension can be a sign of significant blood loss and may be accompanied by other signs of hemodynamic instability.
Prolonged or significant bleeding can lead to fluid loss and dehydration. Signs of dehydration may include dry mucous membranes, decreased skin turgor, and decreased urine output. Some individuals with Mallory-Weiss tears may experience tenderness or discomfort upon palpation of the abdomen, particularly in the epigastric region. Abdominal tenderness can be a nonspecific finding and can also be associated with other conditions.
Differential Diagnoses
Esophageal Varices
Gastric Neoplasm
Peptic Ulcer
In the management of Mallory-Weiss syndrome, the initial focus is on stabilizing the patient’s overall condition, and a traditional approach is generally suitable for most patients. Upon admission, immediate resuscitation should be initiated for patients with active bleeding. Hemodynamic stability is assessed following the ABC protocol, which evaluates the airway, breathing, and circulation. If there is an electrolyte imbalance, appropriate correction should be administered.
To facilitate the recovery of the gastric and esophageal mucosa, H2 blockers and proton pump inhibitors (PPIs) are administered to reduce gastric acidity. Intravenous proton pump inhibitors are typically given initially to patients expected to go under endoscopic examination. Additionally, anti-emetics such as ondansetron and promethazine may be prescribed to manage nausea and vomiting.
It is important to note that Mallory-Weiss syndrome is generally self-limited, and recurrence is uncommon. Therefore, the primary objective in the initial management is to ensure the patient’s stability and provide supportive care. Further treatment options, such as endoscopic interventions, may be considered if necessary, based on the severity of bleeding or other clinical factors.
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