Mallory-Weiss Syndrome

Mallory-Weiss syndrome is characterized by mild to massive and usually painless bleeding. It results from a tear in the mucosa or submucosa of the cardia or lower esophagus. Such a tear, usually singular and longitudinal, results from prolonged or forceful vomiting.

About 60% of these tears involve the cardia; 15%, the terminal esophagus; and 25%, the region across the esophagogastric junction. Mallory-Weiss syndrome is most common in men over age 40, especially alcoholics

Causes

Mallory-Weiss syndrome is usually caused by forceful or prolonged vomiting or coughing. Mallory-Weiss syndrome may also be caused by epileptic convulsions. Any condition that leads to violent and lengthy bouts of coughing or vomiting can cause the tears that lead to Mallory-Weiss Syndrome.

Researchers have discovered that patients with increased pressure in the vein leading into the liver are more likely to bleed heavily from an esophageal laceration than those whose blood pressure is normal.

Signs and Symptoms

A person with this condition will vomit blood or pass black, sticky stools after periods of vomiting, retching or coughing. Immediate medical attention should be sought if these symptoms are present.

Diagnostic tests

Fiber-optic endoscopy of esophageal tears confirms Mallory-Weiss syndrome. In most patients, lesions appear as recently produced, erythematous, longitudinal cracks in the mucosa. In older tears, lesions appear as raised, white streaks surrounded by erythema.

Angiography (selective celiac arteriography) can be used to determine the bleeding site but not the cause. This procedure may be used when endoscopy isn't available.

Serum hematocrit (HCT) helps to quantify blood loss.

Treatment

Because GI bleeding usually stops spontaneously, treatment often consists of supportive measures and careful observation. Treatment must be geared to the severity of bleeding. In some patients, blood transfusion is necessary. If severe bleeding continues, other treatments may include:

• angiography, with infusion of a vasoconstrictor (vasopressin) into the superior mesenteric artery or direct infusion into a vessel that leads to the bleeding artery.
• endoscopy with electrocoagulation or heater probe for hemostasis.
• transcatheter embolization or thrombus formation with an autologous blood clot or other hemostatic material (insertion of artificial material, such as shredded absorbable gelatin sponge or, less often, the patient's own clotted blood through a catheter into the bleeding vessel to aid thrombus formation).
• surgery to suture each laceration (for massive recurrent or uncontrollable bleeding).

Prevention

Mallory-Weiss syndrome is associated with alcoholism. Limiting alcohol intake may help prevent the disorder.