Mallory-Weiss Syndrome

Mild to massive and usually painless bleeding due to a tear in the mucosa or submucosa of the cardia or lower esophagus characterizes Mallory-Weiss syndrome. Such a tear, usually singular and longitudinal, results from prolonged or forceful vomiting. Sixty percent of these tears involve the cardia; 15%, the terminal esophagus; and 25%, the region across the esophagogastric junction. Mallory-Weiss syndrome is most common in men over age 40, especially alcoholics.

Causes

Mallory-Weiss syndrome is usually caused by forceful or prolonged vomiting or coughing. Mallory-Weiss syndrome may also be caused by epileptic convulsions. Any condition that leads to violent and lengthy bouts of coughing or vomiting can cause the tears that lead to Mallory-Weiss Syndrome.

Researchers have discovered that patients with increased pressure in the vein leading into the liver are more likely to bleed heavily from an esophageal laceration than those whose blood pressure is normal.

Signs and symptoms

Typically, Mallory-Weiss syndrome begins with vomiting of blood or passing large amounts of blood rectally a few hours to several days after normal vomiting. This bleeding, which may be accompanied by epigastric or back pain, may range from mild to massive but is generally more profuse than in esophageal rupture.

In Mallory- Weiss syndrome, the blood vessels are only partially severed, preventing retraction and closure of the lumen. Massive bleeding-most likely when the tear is on the gastric side, near the cardia - may quickly lead to fatal shock.

Diagnosis

A Mallory-Weiss syndrome tear is not visible on standard upper gastrointestinal x rays. A tear about one-eighth to one and one-half inches long (0.5-4 cm) is revealed by endoscopy. Endoscopy also shows that in 35% of patients there is another potential cause for gastrointestinal bleeding, such as peptic ulcer, erosive gastritis , or esophageal varices.

Treatment

Appropriate treatment varies with the severity of bleeding. Usually, GI bleeding stops spontaneously, requiring supportive measures and careful observation but no definitive treatment. However, if bleeding continues, treatment may include:

• angiographic infusion of a vasoconstrictor (vasopressin) into the superior mesenteric artery or direct infusion into a vessel that leads to the bleeding artery
• transcatheter embolization or thrombus formation with an autologous blood clot or other hemostatic material (insertion of artificial material, such as a shredded absorbable gelatin sponge or, less often, the patient's own clotted blood through a catheter into the bleeding vessel to aid thrombus formation)
• surgery to suture each laceration (for massive recurrent or uncontrollable bleeding).

Prevention

Mallory-Weiss syndrome is associated with alcoholism. Limiting alcohol intake may help prevent the disorder.