Mallory-Weiss tear

Mallory-Weiss Tear (MWT) accounts for 3% to 15% of patients gastrointestinal (GI) bleed.

Commonly presents with haematemesis after an episode of forceful or recurrent retching, vomiting, coughing, or straining.

Definitive diagnosis is usually made by oesophagogastroduodenoscopy.

MWT is mostly self limiting, so treatment is generally supportive. Emergency treatment is reserved for patients showing signs or symptoms of instability.

First-line treatment in an actively bleeding patient is therapeutic endoscopy. Endoscopy can also help to rule out other causes of upper GI bleeding.

Rarely, angiography with embolisation of the arteries supplying the region, or surgical repair, may be required to control bleeding.

Mallory-Weiss tear (MWT), also known as Mallory-Weiss syndrome (MWS), is characterised by a tear or laceration often along the right border of, or near, the gastro-oesophageal junction. Patients present with non-variceal upper gastrointestinal bleeding. The haemorrhage is usually self-limited, ceasing spontaneously in 80% to 90% of patients.[1]Sugawa C, Benishek D, Walt AJ. Mallory-Weiss syndrome: a study of 224 patients. Am J Surg. 1983;145:30-33. http://www.ncbi.nlm.nih.gov/pubmed/6600377?tool=bestpractice.com

The pathogenesis is not completely understood. However, most patients report an MWT after an event that provokes a sudden rise in the pressure gradient across the gastro-oesophageal junction, such as retching, vomiting, coughing, or straining.