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 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.
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 gastrointestinal bleeding. The hemorrhage is usually self-limited, ceasing spontaneously in 80% to 90% of patients.
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
Other diagnostic factors
- postural/orthostatic hypotension
- signs of anemia
- 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 sex
- aspirin or other nonsteroidal anti-inflammatory drug ingestion
- blunt abdominal trauma
- cardiopulmonary resuscitation
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
Investigations to consider
- creatine kinase (CK)
- creatine kinase-MB (CK-MB)
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
DGA is a consultant for BSC, Merit, Cook, and Olympus.
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.
Joseph Sung, MD
Professor of Medicine
Department of Medicine and Therapeutics
Institute of Digestive Disease
The Chinese University of Hong Kong
JS declares that he has no competing interests.
Imtiyaz Mohammed, MD
Sandwell General Hospital
IM declares that he has no competing interests.
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