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Mallory-Weiss syndrome

Summary

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.

Definition

Think of the double L in MaLLory-Weiss to remember Longitudinal Lacerations.

Epidemiology

References:[1][2]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

References: [2]

Clinical features

References:[2]

Diagnostics

  • Esophagogastroduodenoscopy
    • Often a single longitudinal tear (multiple tears are possible) in the mucosa at the gastroesophageal junction; limited to mucosa and submucosa
    • A clot or active bleeding may be evident.

References:[2]

Differential diagnoses

The differential diagnoses listed here are not exhaustive.

Treatment

General measures

  • If bleedings stops spontaneously conservative treatment is usually sufficient
  • Control of precipitating factors (e.g., omeprazole for GERD)
  • Inpatient monitoring
  • Treat hemodynamic instability if present

Surgical treatment

  • Indication: actively bleeding lesion
  • Gold standard: esophagogastroduodenoscopy
  • Second-line treatment : angiography (embolization, vasopressin infusion)

References:[2][1]

Acute management checklist

  • 1. Song LMWK. Mallory-Weiss Tear Overview of Mallory-Weiss Syndrome. In: Katz J. Mallory-Weiss Tear Overview of Mallory-Weiss Syndrome. New York, NY: WebMD. http://emedicine.medscape.com/article/187134-overview#showall. Updated June 25, 2015. Accessed January 4, 2017.
  • 2. Guelrud M. Mallory-Weiss syndrome. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/mallory-weiss-syndrome. Last updated March 18, 2014. Accessed January 4, 2017.
  • 3. Kim H-S. Endoscopic Management of Mallory-Weiss Tearing. Clin Endosc. 2015; 48(2): p. 102. doi: 10.5946/ce.2015.48.2.102.
  • 4. Loffroy R, Favelier S, Pottecher P, et al. Transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding: Indications, techniques and outcomes. Diagn Interv Imaging. 2015; 96(7-8): pp. 731–744. doi: 10.1016/j.diii.2015.05.002.
  • Herold G. Internal Medicine. Cologne, Germany: Herold G; 2014.
  • Rawla, Prashanth; Devasahayam, Joe. Mallory Weiss Syndrome. https://www.ncbi.nlm.nih.gov/books/NBK538190/. Updated November 24, 2019. Accessed January 6, 2020.
last updated 03/20/2020
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