• Clinical science

Mallory-Weiss syndrome

Abstract

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

  • Longitudinal mucous membrane tears (limited to the mucosa and submucosa) at the gastroesophageal junction
    • Tears may extend above or below the gastroesophageal junction.

Epidemiology

References:[1][2]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

References: [2]

Clinical features

  • May be asymptomatic
  • Epigastric or back pain
  • Hematemesis
  • Possible shock with massive hemorrhage

References:[2]

Diagnostics

  • Esophagogastroduodenoscopy
    • 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)

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 for 24–48 hours
  • Treat hemodynamic instability if present

Surgical treatment

  • Indication: actively bleeding lesion
  • Gold standard: esophagogastroduodenoscopy
    • Therapeutic injection of an adrenaline solution or a fibrin sealant
    • Electrocoagulation
    • Endoscopic band ligation
    • Hemoclips
    • 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

References:[2][1]

Complications

We list the most important complications. The selection is not exhaustive.

last updated 10/16/2018
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