Detailed Information on Mallory-Weiss Syndrome

Mallory-Weiss syndrome is a condition in which the inner lining of the esophagus tears at or near where it connects to the stomach. Mallory-Weiss syndrome may also be caused by epileptic convulsions. Mallory-Weiss tears cause approximately 10-15% of all episodes of hematemesis in adults; however, these tears occur much less commonly in children. Mallory-Weiss syndrome is often associated with alcoholism and eating disorders and there is some evidence that presence of a hiatal hernia is a predisposing condition. Mallory-Weiss syndrome is usually caused by forceful or prolonged vomiting or coughing.

Mallory-Weiss syndrome is the result of about 5% of episodes of upper GI hemorrhage. Most episodes of bleeding impede spontaneously; severe bleeding occurs in about 10% of patients who need significant intervention. Mallory-Weiss tears are equally common among male and female children. These tears also arise with equal frequency in both sexes in adults, although they have different causes. About 10% of the tears are in the esophagus. Most are either right at the junction of the esophagus and stomach or in the stomach just slightly below the junction. Bleeding from the tear causes a disruption in fluid and electrolyte balance of the body.

In most cases, the bleeding stops spontaneously after 24-48 hours. The patient frequently produces vomit tinged with either fresh blood or older, blackish blood. Blood loss can be considerable. Mallory-Weiss tears usually arise in the fifth and sixth decades of life. In children, tears are more commonly observed in older children and adolescents secondary to increased intragastric and transgastric pressures that develop at an older age. Treatment is usually supportive as persistent bleeding is uncommon. Medications to decrease vomiting are often prescribed. The blood transfusions and intravenous fluids will help restore the fluid and electrolyte balance.

When bleeding does not stop, cauterization or injection of epinephrine to stop the bleeding may be undertaken during the index endoscopy procedure. Esophageal balloon tamponade, although useful for patients with esophageal varices, should be believed only in extreme cases because the use of an esophageal balloon increases the risk of extending the esophageal tear. If all these treatments fail, surgery is performed to stop the bleeding and 5% of cases require surgery for uncontrolled bleeding. Prevention is better than cure. Limiting alcohol intake may assist prevent the disorder.

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