Mallory-Weiss Tear (MWT) accounts for 5% to 15% of patients with gastrointestinal (GI) bleed.
Commonly presents with haematemesis after an episode of forceful or recurrent retching, vomiting, coughing, or straining.
Definitive diagnosis is made by upper GI endoscopy.
MWT is mostly self limiting, so treatment is generally supportive. Haemodynamically unstable patients with haematochezia and other historical factors suggesting upper GI bleeding require urgent investigation and treatment.
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, interventional radiology or surgery may be required to control bleeding.
Mallory-Weiss tear, also known as Mallory-Weiss syndrome, is a longitudinal mucosal tear or laceration of the mucous membrane in the region of the gastroesophageal junction and gastric cardia.
Patients present with non-variceal upper gastrointestinal bleeding. The haemorrhage is self-limiting in 80% to 90% of patients.
History and exam
Key diagnostic factors
- presence of risk factors
Other diagnostic factors
- postural/orthostatic hypotension
- retrosternal, epigastric, or back pain
- signs of anaemia
- condition predisposing to retching, vomiting, and/or straining
- chronic cough
- hiatal hernia
- endoscopy or other instrumentation
- heavy alcohol use
- age 30 to 50 years
- male sex
- blunt abdominal trauma
- cardiopulmonary resuscitation
1st investigations to order
- full blood count
- urea and creatinine
- liver function tests
- cross-matching/blood grouping
Investigations to consider
- prothrombin time/international normalized ratio (PT/INR)
- activated partial thromboplastin time (PTT)
- chest x-ray
- abdominal CT
- CT angiogram
active non-variceal bleeding
Neeraj Bhala, DPhil(Oxon), FRACP, FRCPE
Site Lead of Gastrointestinal Medicine
Queen Elizabeth Hospital Birmingham
University Hospitals Birmingham
NB declares that he has no competing interests.
DBMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work is retained in parts of the content:
Douglas G. Alder, MD, FACG, AGAF, FASGE
Professor of Medicine
Division of Gastroenterology
Department of Internal Medicine
Huntsman Cancer Institute
University of Utah
Salt Lake City
Ian Beales, BSc, FEBG, MD, MRCP
Clinical Associate Professor
Norwich Medical School
Department of Gastroenterology
Norfolk and Norwich University Hospital
IB declares that he has no competing interests.
Section Editor, BMJ Best Practice
HDC declares that she has no competing interests.
Lead Section Editor, BMJ Best Practice
TAO declares that she has no competing interests.
Comorbidities Editor, BMJ Best Practice
JC declares that she has no competing interests.
Drug Editor, BMJ Best Practice
AM declares that he has no competing interests.
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