Mallory–Weiss syndrome

Mallory–Weiss syndrome
Classification and external resources
ICD-10 K22.6
ICD-9 530.7
DiseasesDB 7803
eMedicine ped/1359
MeSH D008309

Mallory–Weiss syndrome or gastro-esophageal laceration syndrome refers to bleeding from tears (a Mallory-Weiss tear) in the mucosa at the junction of the stomach and esophagus, usually caused by severe retching, coughing, or vomiting.

Contents

Causes

It is often associated with alcoholism[1] and eating disorders and there is some evidence that presence of a hiatal hernia is a predisposing condition. Forceful vomiting causes tear of the mucosa at the junction.

NSAID abuse is also a rare association. The tear involves mucosa and submucosa but not the muscular layer (contrast to Boerhaave syndrome which involves all the layers).[2] The mean age is more than 60 and 80% are men. Hyperemesis gravidarum which is severe morning sickness associated with vomiting and retching in pregnancy also is a known cause of Mallory weiss tear.[3]

Presentation

Mallory–Weiss syndrome often presents as an episode of vomiting up blood (hematemesis) after violent retching or vomiting, but may also be noticed as old blood in the stool (melena), and a history of retching may be absent.

In most cases, the bleeding stops spontaneously after 24–48 hours, but endoscopic or surgical treatment is sometimes required and rarely the condition is fatal.

Diagnosis

Definitive diagnosis is by endoscopy.

Treatment

Treatment is usually supportive as persistent bleeding is uncommon. However cauterization or injection of epinephrine[4] to stop the bleeding may be undertaken during the index endoscopy procedure.

Very rarely embolization of the arteries supplying the region may be required to stop the bleeding. If all other methods fail, high gastrostomy can be used to ligate the bleeding vessel.

S.B. tube will not be able to stop bleeding as here the bleeding is arterial and the pressure in the balloon is not sufficient to overcome the arterial pressure.

History

The condition was first described in 1929 by G. Kenneth Mallory and Soma Weiss in 15 alcoholic patients.[5]

See also

References

  1. ^ Caroli A, Follador R, Gobbi V, Breda P, Ricci G (1989). "[Mallory-Weiss syndrome. Personal experience and review of the literature]" (in Italian). Minerva dietologica e gastroenterologica 35 (1): 7–12. PMID 2657497. 
  2. ^ Boerhaave Syndrome at eMedicine
  3. ^ Parva M, Finnegan M, Keiter C, Mercogliano G, Perez CM (August 2009). "Mallory-Weiss tear diagnosed in the immediate postpartum period: a case report". J Obstet Gynaecol Can 31 (8): 740–3. PMID 19772708. 
  4. ^ Gawrieh S, Shaker R (2005). "Treatment of actively bleeding Mallory-Weiss syndrome: epinephrine injection or band ligation?". Current gastroenterology reports 7 (3): 175. PMID 15913474. 
  5. ^ Weiss S, Mallory GK (1932). "Lesions of the cardiac orifice of the stomach produced by vomiting". Journal of the American Medical Association 98: 1353–5.