Mallory-Weiss tear

Mallory-Weiss tear (MWT) accounts for about 5% to 7% of people with upper gastrointestinal (GI) bleed.

Commonly presents with hematemesis after an episode of forceful or recurrent retching, vomiting, coughing, or straining. Hematemesis can be intermittent or brisk.

Patients can be assessed for risk using the Glasgow Blatchford Score (GBS). Low-risk patients can be discharged with outpatient follow-up. Patients with a GBS score of ≥2 should be admitted and have an esophagogastroduodenoscopy within 24 hours.

MWT is mostly self-limiting, so treatment is generally supportive. Emergency treatment is reserved for those showing signs or symptoms of instability or with evidence of active, ongoing bleeding.

Esophagogastroduodenoscopy will usually provide a definitive diagnosis and the opportunity to treat active bleeding.

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

MWT, also known as Mallory-Weiss syndrome (MWS), is characterized by a tear or laceration often along the right border of, or near, the gastroesophageal junction. Patients present with nonvariceal upper gastrointestinal bleeding. The hemorrhage is usually self-limited.[1]Alali AA, Barkun AN. An update on the management of non-variceal upper gastrointestinal bleeding. Gastroenterol Rep (Oxf). 2023 Mar 20;11:goad011. https://academic.oup.com/gastro/article/doi/10.1093/gastro/goad011/7081277 http://www.ncbi.nlm.nih.gov/pubmed/36949934?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 gastroesophageal junction, such as retching, vomiting, coughing, or straining.