Mallory-Weiss syndrome
Encyclopedia
Mallory–Weiss syndrome or gastro-esophageal laceration syndrome refers to bleeding from tears (a Mallory-Weiss tear) in the mucosa at the junction of the stomach
and esophagus
, usually caused by severe retching
, cough
ing, or vomiting
.
and eating disorders and there is some evidence that presence of a hiatal hernia
is a predisposing condition. Forceful vomiting causes tear of the mucosa at the junction.
NSAID abuse is also a rare association. The tear involves mucosa and submucosa but not the muscular layer (contrast to Boerhaave syndrome
which involves all the layers). The mean age is more than 60 and 80% are men.
Hyperemesis gravidarum which is severe morning sickness associated with vomiting and retching in pregnancy also is a known cause of Mallory weiss tear.[3]
) after violent retching or vomiting, but may also be noticed as old blood in the stool (melena
), and a history of retching may be absent.
In most cases, the bleeding stops spontaneously after 24–48 hours, but endoscopic or surgical treatment is sometimes required and rarely the condition is fatal.
or injection of epinephrine
to stop the bleeding may be undertaken during the index endoscopy procedure.
Very rarely embolization
of the arteries supplying the region may be required to stop the bleeding. If all other methods fail, high gastrostomy can be used to ligate the bleeding vessel.
S.B. tube will not able to stop bleeding as here the bleeding is arterial and the pressure in the balloon is not sufficient to overcome the arterial pressure.
in 15 alcoholic patients.
Stomach
The stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract in some animals, including vertebrates, echinoderms, insects , and molluscs. It is involved in the second phase of digestion, following mastication .The stomach is...
and esophagus
Esophagus
The esophagus is an organ in vertebrates which consists of a muscular tube through which food passes from the pharynx to the stomach. During swallowing, food passes from the mouth through the pharynx into the esophagus and travels via peristalsis to the stomach...
, usually caused by severe retching
Retching
Retching is a process in the human body where gastric contents are forced into the esophagus but do not enter the pharynx. Retching usually precedes vomiting, when the upper esophageal sphincter remains closed. If the upper esophageal sphincter is open, vomiting occurs. It can also be caused by a...
, cough
Cough
A cough is a sudden and often repetitively occurring reflex which helps to clear the large breathing passages from secretions, irritants, foreign particles and microbes...
ing, or vomiting
Vomiting
Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...
.
Causes
It is often associated with alcoholismAlcoholism
Alcoholism is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's health, personal relationships, and social standing...
and eating disorders and there is some evidence that presence of a hiatal hernia
Hiatus hernia
A hiatus hernia or hiatal hernia is the protrusion of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm.- Classification :There are two major kinds of hiatus hernia:...
is a predisposing condition. Forceful vomiting causes tear of the mucosa at the junction.
NSAID abuse is also a rare association. The tear involves mucosa and submucosa but not the muscular layer (contrast to Boerhaave syndrome
Boerhaave syndrome
Esophageal rupture is rupture of the esophageal wall due to vomiting. 56% of esophageal perforations are iatrogenic, usually due to medical instrumentation such as an endoscopy or paraesophageal surgery...
which involves all the layers). The mean age is more than 60 and 80% are men.
Hyperemesis gravidarum which is severe morning sickness associated with vomiting and retching in pregnancy also is a known cause of Mallory weiss tear.[3]
Presentation
Mallory–Weiss syndrome often presents as an episode of vomiting up blood (hematemesisHematemesis
Hematemesis or haematemesis is the vomiting of blood. The source is generally the upper gastrointestinal tract. Patients can easily confuse it with hemoptysis , although the latter is more common.-Signs:...
) after violent retching or vomiting, but may also be noticed as old blood in the stool (melena
Melena
In medicine, melena or melaena refers to the black, "tarry" feces that are associated with gastrointestinal hemorrhage. The black color is caused by oxidation of the iron in hemoglobin during its passage through the ileum and colon.-Melena vs...
), and a history of retching may be absent.
In most cases, the bleeding stops spontaneously after 24–48 hours, but endoscopic or surgical treatment is sometimes required and rarely the condition is fatal.
Treatment
Treatment is usually supportive as persistent bleeding is uncommon. However cauterizationCauterization
The medical practice or technique of cauterization is the burning of part of a body to remove or close off a part of it in a process called cautery, which destroys some tissue, in an attempt to mitigate damage, remove an undesired growth, or minimize other potential medical harmful possibilities...
or injection of epinephrine
Epinephrine
Epinephrine is a hormone and a neurotransmitter. It increases heart rate, constricts blood vessels, dilates air passages and participates in the fight-or-flight response of the sympathetic nervous system. In chemical terms, adrenaline is one of a group of monoamines called the catecholamines...
to stop the bleeding may be undertaken during the index endoscopy procedure.
Very rarely embolization
Embolization
Embolization is a non-surgical, minimally-invasive procedure performed by an interventional radiologist and interventional neuroradiologists. It involves the selective occlusion of blood vessels by purposely introducing emboli.-Therapeutic applications:...
of the arteries supplying the region may be required to stop the bleeding. If all other methods fail, high gastrostomy can be used to ligate the bleeding vessel.
S.B. tube will not able to stop bleeding as here the bleeding is arterial and the pressure in the balloon is not sufficient to overcome the arterial pressure.
History
The condition was first described in 1929 by G. Kenneth Mallory and Soma WeissSoma Weiss
Soma Weiss was born in Beszterce, Transylvania, then part of Hungary. He studied physiology and biochemistry in Budapest. Immediately after the end of World War I, he emigrated to the United States and qualified in medicine in 1923...
in 15 alcoholic patients.
See also
- Boerhaave syndromeBoerhaave syndromeEsophageal rupture is rupture of the esophageal wall due to vomiting. 56% of esophageal perforations are iatrogenic, usually due to medical instrumentation such as an endoscopy or paraesophageal surgery...
- Full thickness esophageal ruptures also often secondary to vomiting/retching. - HematemesisHematemesisHematemesis or haematemesis is the vomiting of blood. The source is generally the upper gastrointestinal tract. Patients can easily confuse it with hemoptysis , although the latter is more common.-Signs:...