- Clinical science
Mallory-Weiss syndrome refers to acute upper gastrointestinal bleeding caused by mucous membrane lacerations at the gastroesophageal junction, although it may extend above or below. Forceful vomiting in the presence of a damaged gastric mucous membrane, often related to alcoholism, is a common cause of Mallory-Weiss syndrome. Patients typically present with a history of epigastric pain and hematemesis. Esophagogastroduodenoscopy is important in both the diagnosis of the condition and its treatment, which involves simultaneous hemostasis.
Longitudinal mucous membrane tears (limited to the mucosa and submucosa) at the gastroesophageal junction
- Tears may extend above or below the gastroesophageal junction.
- Sex: ♂ > ♀ (3:1)
- Mallory-Weiss lesions account for approx. 5% of cases of gastrointestinal bleeding
Epidemiological data refers to the US, unless otherwise specified.
- Mechanism:: A sudden and severe rise in the esophageal intraluminal pressure results in tearing of the esophageal mucous membrane, as well as the submucosal arteries and veins
- Severe vomiting
- Blunt abdominal trauma
- Strained defecation
- Predisposing conditions
- Often a single longitudinal tear (multiple tears are possible) in the mucosa at the esophagogastric junction
- A clot or active bleeding may be evident
- Possible coexisting lesions if there is a predisposing condition (e.g., esophageal ulcers in GERD)
- Esophageal ulcers
The differential diagnoses listed here are not exhaustive.
- If bleedings stops spontaneously conservative treatment is usually sufficient
- Control of precipitating factors (e.g., omeprazole for GERD)
- Inpatient monitoring for 24–48 hours
- Treat hemodynamic instability if present
- Indication: actively bleeding lesion
Gold standard: esophagogastroduodenoscopy
- Therapeutic injection of an adrenaline solution or a fibrin sealant
- Endoscopic band ligation
- Balloon tamponade is no longer considered because of the risk of esophageal perforation.
- Second-line treatment : angiography (embolization, vasopressin infusion) or open surgery (rarely necessary): surgical ligation of bleeding vessels
- Heavy bleeding → hypovolemic shock
We list the most important complications. The selection is not exhaustive.