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Mallory-Weiss tear

Last reviewed: 10 Nov 2023
Last updated: 21 Jun 2022



History and exam

Key diagnostic factors

  • hematemesis
More key diagnostic factors

Other diagnostic factors

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

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 sex
  • aspirin or other nonsteroidal anti-inflammatory drug ingestion
  • hiccups
  • blunt abdominal trauma
  • cardiopulmonary resuscitation
More risk factors

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
More 1st investigations to order

Investigations to consider

  • creatine kinase (CK)
  • creatine kinase-MB (CK-MB)
  • troponin
  • ECG
  • angiography
More investigations to consider

Treatment algorithm


all patients



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.

Peer reviewers

Joseph Sung, MD

Professor of Medicine

Department of Medicine and Therapeutics


Institute of Digestive Disease

The Chinese University of Hong Kong

Hong Kong


JS declares that he has no competing interests.

Imtiyaz Mohammed, MD

Consultant Gastroenterologist

Sandwell General Hospital


West Bromwich



IM declares that he has no competing interests.

  • Mallory-Weiss tear images
  • Differentials

    • Esophagitis
    • Spontaneous esophageal perforation (Boerhaave syndrome)
    • Cameron erosions
    More Differentials
  • Guidelines

    • Management of anticoagulants and antiplatelets during acute gastrointestinal bleeding and the periendoscopic period
    • Management of nonvariceal upper gastrointestinal bleeding
    More Guidelines
  • Patient leaflets



    More Patient leaflets
  • Calculators

    Blatchford score for gastrointestinal bleeding

    Rockall Score for Upper Gastrointestinal Bleeding

    More Calculators
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