Mallory-Weiss tear

Last reviewed: 9 Nov 2022
Last updated: 09 May 2022



History and exam

Key diagnostic factors

  • presence of risk factors
  • haematemesis
Full details

Other diagnostic factors

  • light-headedness/dizziness
  • postural/orthostatic hypotension
  • dysphagia
  • odynophagia
  • retrosternal, epigastric, or back pain
  • melaena
  • haematochezia
  • shock
  • signs of anaemia
Full details

Risk factors

  • 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
  • hiccups
  • blunt abdominal trauma
  • cardiopulmonary resuscitation
Full details

Diagnostic investigations

1st investigations to order

  • gastroscopy
  • full blood count
  • urea and creatinine
  • liver function tests
  • cross-matching/blood grouping
Full details

Investigations to consider

  • prothrombin time/international normalized ratio (PT/INR)
  • activated partial thromboplastin time (PTT)
  • chest x-ray
  • abdominal CT
  • CT angiogram
Full details

Treatment algorithm


active non-variceal bleeding


Expert advisers

Neeraj Bhala, DPhil(Oxon), FRACP, FRCPE

Consultant Gastroenterologist

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


Peer reviewers

Ian Beales, BSc, FEBG, MD, MRCP

Consultant Gastroenterologist

Clinical Associate Professor

Norwich Medical School

Department of Gastroenterology

Norfolk and Norwich University Hospital





IB declares that he has no competing interests.


Helena Delgado-Cohen

Section Editor, BMJ Best Practice


HDC declares that she has no competing interests.

Tannaz Aliabadi-Oglesby

Lead Section Editor, BMJ Best Practice


TAO declares that she has no competing interests.

Julie Costello

Comorbidities Editor, BMJ Best Practice


JC declares that she has no competing interests.

Adam Mitchell

Drug Editor, BMJ Best Practice


AM declares that he has no competing interests.

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