Mallory-Weiss tear

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 17 Jun 2025

Last updated: 08 Jul 2025

Mallory-Weiss Tear (MWT) accounts for 5% to 7% of patients with gastrointestinal (GI) bleed.

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

Definitive diagnosis is made by upper GI endoscopy.

MWT is mostly self limiting, so treatment is generally supportive. Haemodynamically unstable patients with haematochezia and other historical factors suggesting upper GI bleeding require urgent investigation and treatment.

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, interventional radiology or surgery may be required to control bleeding.

Definition

Mallory-Weiss tear, also known as Mallory-Weiss syndrome, is a longitudinal mucosal tear or laceration of the mucous membrane in the region of the gastroesophageal junction and gastric cardia.[1]

Patients present with non-variceal upper gastrointestinal bleeding. The haemorrhage is self-limiting in most patients.[2]

History and exam

Key diagnostic factors

presence of risk factors
haematemesis

Full details

Other diagnostic factors

light-headedness/dizziness
postural/orthostatic hypotension
dysphagia or odynophagia
retrosternal, epigastric, or back pain
melaena
haematochezia
shock
signs of anaemia

Full details

Risk factors

condition predisposing to retching, vomiting, and/or straining
chronic cough
hiatal hernia
endoscopy or other instrumentation
heavy alcohol use
age 30 to 50 years
male sex
hiccups
blunt abdominal trauma
cardiopulmonary resuscitation

Full details

Diagnostic investigations

1st investigations to order

gastroscopy
full blood count
urea and creatinine
liver function tests
cross-matching/blood grouping

Full details

Investigations to consider

prothrombin time/international normalised ratio (PT/INR)
activated partial thromboplastin time (PTT)
chest and abdominal CT
chest x-ray
CT angiogram

Full details

Treatment algorithm

ACUTE

active non-variceal bleeding

Contributors

Expert advisers

Ian Beales, BSc, FEBG, MD, MRCP

Consultant Gastroenterologist

Department of Gastroenterology

Norfolk and Norwich University Hospital

Norwich

Disclosures

IB declares that he has no competing interests.

Acknowledgements

BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work is retained in parts of the content:

Neeraj Bhala DPhil(Oxon), FRACP, FRCPE

Consultant Gastroenterologist

Site Lead of Gastrointestinal Medicine

Queen Elizabeth Hospital

University Hospitals Birmingham

Birmingham

Disclosures

NB declares that he has no competing interests.

Peer reviewers

Adrian Stanley, MBChB, MD, FRCPEd, FRCPSGlasg

Honorary Professor

Consultant Gastroenterologist

NHS Greater Glasgow and Clyde

Glasgow

Disclosures

AS declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Siau K, Hearnshaw S, Stanley AJ, et al. British Society of Gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding. Frontline Gastroenterol. 2020 Mar 27;11(4):311-23.Full text Abstract

Gralnek IM, Stanley AJ, Morris AJ, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) guideline - update 2021. Endoscopy. 2021 Mar;53(3):300-32.Full text Abstract

National Institute for Health and Care Excellence. Acute upper gastrointestinal bleeding in over 16s: management. August 2016 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Oesophagitis
- Spontaneous oesophageal perforation (Boerhaave's syndrome)
- Cameron erosions
More Differentials
Guidelines
- British Society of Gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding
- Acute upper gastrointestinal bleeding in over 16s: management
More Guidelines
Calculators
Blatchford Score for Gastrointestinal Bleeding
Rockall Score for Upper Gastrointestinal Bleeding
More Calculators
Videos
Bleeding Mallory Weiss tear
Mallory Weiss tear following cauterisation with a bipolar probe
More videos
Patient information
Bulimia: what is it?
Bulimia: what treatments work?
More Patient information
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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

active non-variceal bleeding

Contributors

Expert advisers

Ian Beales, BSc, FEBG, MD, MRCP

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Adrian Stanley, MBChB, MD, FRCPEd, FRCPSGlasg

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Calculators

Videos

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice