Mallory-Weiss tear

Last reviewed: December 2018

Last updated: March 2018

Summary

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

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

Definitive diagnosis is usually made by esophagogastroduodenoscopy.

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

First-line treatment in an actively bleeding patient is therapeutic endoscopy. Endoscopy is probably the most sensitive and specific diagnostic test for MWT and can also help to rule out other causes of upper GI bleeding.

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

Definition

Mallory-Weiss tear (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 GI bleeding. The hemorrhage is usually self-limited, ceasing spontaneously in 80% to 90% of patients. [1] 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.

History and exam

Key diagnostic factors

hematemesis

Full details

Other diagnostic factors

light-headedness/dizziness
postural/orthostatic hypotension
dysphagia
odynophagia
pain
melena
hematochezia
shock
signs of anemia

Full details

Risk factors

condition predisposing to retching, vomiting, and/or straining
chronic cough
hiatus hernia
retching during endoscopy or other instrumentation
significant alcohol use
previous instrumentation
age 30 to 50 years
male gender
aspirin or other NSAIDs ingestion
hiccups
blunt abdominal trauma
cardiopulmonary resuscitation
primal scream therapy

Full details

Diagnostic investigations

1st investigations to order

Complete blood count (CBC)
Blood urea nitrogen (BUN)
Liver function test (LFT)
Prothrombin time/International normalized ratio (PT/INR)
Partial thromboplastin time (PTT)
Chest x-ray (CXR)
esophagogastroduodenoscopy (EGD)
cross matching/blood grouping

Full details

Investigations to consider

creatine kinase (CK)
creatine kinase-MB (CK-MB)
troponin
ECG
angiography

Full details

Treatment algorithm

ACUTE

all patients

Contributors

Authors VIEW ALL 

Douglas G. Adler, MD, FACG, AGAF, FASGE

Professor of Medicine

Division of Gastroenterology

Department of Internal Medicine

Huntsman Cancer Institute

University of Utah

Salt Lake City

Disclosures

DGA declares that he has no competing interests.

Acknowledgements

Dr Douglas Adler would like to gratefully acknowledge Dr Shilpa Reddy and Dr Juan Carlos Munoz, the previous contributors to this topic. SR and JCM declare that they have no competing interests.

Peer reviewers VIEW ALL 

Joseph Sung, MD

Professor of Medicine

Department of Medicine and Therapeutics

Director

Institute of Digestive Disease

The Chinese University of Hong Kong

Hong Kong

Disclosures

JS declares that he has no competing interests.

Imtiyaz Mohammed, MD

Consultant Gastroenterologist

Sandwell General Hospital

Lyndon

West Bromwich

Disclosures

IM declares that he has no competing interests.

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Mallory-Weiss tear

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

all patients

Contributors

Authors VIEW ALL 

Douglas G. Adler, MD, FACG, AGAF, FASGE

Disclosures

Acknowledgements

Peer reviewers VIEW ALL 

Joseph Sung, MD

Disclosures

Imtiyaz Mohammed, MD

Disclosures

Differentials

Guidelines

Patient leaflets

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