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Mallory–Weiss syndrome
Mallory–Weiss tear affecting the esophageal side of the gastroesophageal junction
Specialty
Gastroenterology
Mallory–Weiss syndrome or gastro-esophageal laceration syndrome refers to bleeding from a laceration in the mucosa at the junction of the stomach and esophagus. This is usually caused by severe vomiting because of alcoholism or bulimia,[1] but can be caused by any conditions which causes violent vomiting and retching such as food poisoning. The syndrome presents with hematemesis. The laceration is sometimes referred to as a Mallory-Weiss tear.
Contents
1Presentation
2Causes
3Diagnosis
4Treatment
5History
6See also
7References
8External links
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 the condition is rarely fatal.[citation needed]
Causes
It is often associated with alcoholism[2] and eating disorders and there is some evidence that presence of a hiatal hernia is a predisposing condition. Forceful vomiting causes tearing of the mucosa at the junction. NSAID abuse is also a rare association.[citation needed] In rare instances some chronic disorders like Ménière's disease that cause long term nausea and vomiting could be a factor.
The tear involves the mucosa and submucosa but not the muscular layer (contrast to Boerhaave syndrome which involves all the layers).[3] The mean age is more than 60 and 80% are men.[citation needed]
Hyperemesis gravidarum, which is severe morning sickness associated with vomiting and retching in pregnancy, is also a known cause of Mallory-Weiss tear.[4]
Diagnosis
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Definitive diagnosis is by endoscopy. Proper history taking by the medical doctor to distinguish other conditions that cause haematemesis but definitive diagnosis is by conducting esophagogastroduodenoscopy.
Treatment
Treatment is usually supportive as persistent bleeding is uncommon. However cauterization or injection of epinephrine[5] 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. It is to be noted that the 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.[6]
See also
Boerhaave syndrome – Full thickness esophageal ruptures also often secondary to vomiting/retching.
Hematemesis
References
^Sattar, Husain A. (2011). Fundamentals of Pathology. Pathoma, LLC. ISBN 9780983224600.
^Caroli A, Follador R, Gobbi V, Breda P, Ricci G (1989). "[Mallory-Weiss syndrome. Personal experience and review of the literature]". Minerva dietologica e gastroenterologica (in Italian). 35 (1): 7–12. PMID 2657497.
^Boerhaave Syndrome at eMedicine
^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.
^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.
^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. doi:10.1001/jama.1932.02730420011005.
External links
Classification
D
ICD-10: K22.6
ICD-9-CM: 530.7
MeSH: D008309
DiseasesDB: 7803
External resources
MedlinePlus: 000269
eMedicine: ped/1359
Patient UK:
Mallory–Weiss syndrome
v
t
e
Diseases of the digestive system (primarily K20–K93, 530–579)
Upper GI tract
Esophagus
Esophagitis
Candidal
Eosinophilic
Herpetiform
Rupture
Boerhaave syndrome
Mallory–Weiss syndrome
UES
Zenker's diverticulum
LES
Barrett's esophagus
Esophageal motility disorder
Nutcracker esophagus
Achalasia
Diffuse esophageal spasm
Gastroesophageal reflux disease (GERD)
Laryngopharyngeal reflux (LPR)
Esophageal stricture
Megaesophagus
Stomach
Gastritis
Atrophic
Ménétrier's disease
Gastroenteritis
Peptic (gastric) ulcer
Cushing ulcer
Dieulafoy's lesion
Dyspepsia
Pyloric stenosis
Achlorhydria
Gastroparesis
Gastroptosis
Portal hypertensive gastropathy
Gastric antral vascular ectasia
Gastric dumping syndrome
Gastric volvulus
Lower GI tract: Intestinal/ Enteropathy
Small intestine (Duodenum/Jejunum/Ileum)
Enteritis
Duodenitis
Jejunitis
Ileitis
Peptic (duodenal) ulcer
Curling's ulcer
Malabsorption: Coeliac
Tropical sprue
Blind loop syndrome
Small bowel bacterial overgrowth syndrome
Whipple's
Short bowel syndrome
Steatorrhea
Milroy disease
Bile acid malabsorption
Large intestine (Appendix/Colon)
Appendicitis
Colitis
Pseudomembranous
Ulcerative
Ischemic
Microscopic
Collagenous
Lymphocytic
Functional colonic disease
IBS
Intestinal pseudoobstruction / Ogilvie syndrome
Megacolon / Toxic megacolon
Diverticulitis/Diverticulosis
Large and/or small
Enterocolitis
Necrotizing
Gastroenterocolitis
IBD
Crohn's disease
Vascular: Abdominal angina
Mesenteric ischemia
Angiodysplasia
Bowel obstruction: Ileus
Intussusception
Volvulus
Fecal impaction
Constipation
Diarrhea
Infectious
Intestinal adhesions
Rectum
Proctitis
Radiation proctitis
Proctalgia fugax
Rectal prolapse
Anismus
Anal canal
Anal fissure/Anal fistula
Anal abscess
Hemorrhoid
Anal dysplasia
Pruritus ani
GI bleeding/BIS
Upper
Hematemesis
Melena
Lower
Hematochezia
Accessory
Liver
Hepatitis
Viral hepatitis
Autoimmune hepatitis
Alcoholic hepatitis
Cirrhosis
PBC
Fatty liver
NASH
Vascular
Budd-Chiari syndrome
Hepatic veno-occlusive disease
Portal hypertension
Nutmeg liver
Alcoholic liver disease
Liver failure
Hepatic encephalopathy
Acute liver failure
Liver abscess
Pyogenic
Amoebic
Hepatorenal syndrome
Peliosis hepatis
Metabolic disorders
Wilson's disease
Hemochromatosis
Gallbladder
Cholecystitis
Gallstones/Cholecystolithiasis
Cholesterolosis
Adenomyomatosis
Postcholecystectomy syndrome
Porcelain gallbladder
Bile duct/ Other biliary tree
Cholangitis
Primary sclerosing cholangitis
Secondary sclerosing cholangitis
Ascending
Cholestasis/Mirizzi's syndrome
Biliary fistula
Haemobilia
Gallstones/Cholelithiasis
Common bile duct
Choledocholithiasis
Biliary dyskinesia
Sphincter of Oddi dysfunction
Pancreatic
Pancreatitis
Acute
Chronic
Hereditary
Pancreatic abscess
Pancreatic pseudocyst
Exocrine pancreatic insufficiency
Pancreatic fistula
Abdominopelvic
Hernia
Diaphragmatic
Congenital
Hiatus
Inguinal
Indirect
Direct
Umbilical
Femoral
Obturator
Spigelian
Lumbar
Petit's
Grynfeltt-Lesshaft
Undefined location
Incisional
Internal hernia
Richter's
Peritoneal
Peritonitis
Spontaneous bacterial peritonitis
Hemoperitoneum
Pneumoperitoneum
UpToDate Contents
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…for diagnosis and potential treatment. Mallory-Weiss tears that are actively bleeding (spurting or oozing hemorrhage) require endoscopic therapy. Mallory-Weiss tears that are not actively bleeding can be …
…electrocoagulation or combination therapy for the treatment of Mallory-Weiss tears. The application of endoclips in Mallory-Weiss tears is similar to treatment of acute ulcers or acute postpolypectomy …
…lesions (varices, angiodysplasia), mass lesions (adenocarcinoma, polyps), or traumatic lesions (Mallory-Weiss tear). Of note, the source of bleeding cannot be identified in 10 to 15 percent of patients with …
…hemodynamically stable patients with small amounts of blood in the vomitus with a likely explanation (eg, Mallory-Weiss tear), supportive care with observation generally is sufficient, usually with acid suppression to …
Successful Management of Sengstaken-Blakemore Tube-Induced Esophageal Perforation Using Metallic Covered Stent for a Patient with a History of Variceal Bleeding.
… Although the patient did not struggle or retch during endoscopy, multiple mucosal lacerations were observed in the proximal stomach by Mallory-Weiss tears. …
A Mallory-Weiss tear occurs in the mucus membrane of the lower part of the esophagus or upper part of the stomach, near where they join. The tear may bleed.
Severe and prolonged vomiting can result in tears in the lining of the esophagus. The esophagus is the tube that connects your throat to your stomach. Mallory-Weiss syndrome (MWS) is a condition marked by a tear in ...
Your esophagus is the tube that carries food from your throat to your stomach. It plays a vital role in digestion. Sometimes, violent coughing or vomiting can tear the tissue of your lower esophagus and it can start to bleed. The ...