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)
- Spontaneous esophageal perforation (Boerhaave syndrome)
- Cameron erosions
- Management of anticoagulants and antiplatelets during acute gastrointestinal bleeding and the periendoscopic period
- Management of nonvariceal upper gastrointestinal bleeding
HerniaMore Patient leaflets
Blatchford score for gastrointestinal bleeding
Rockall Score for Upper Gastrointestinal BleedingMore Calculators
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