De Mallory–Weiss syndrome
Mrs. Shailaja KS, Mrs. Purohit Saraswati, Mrs. Rashmi P, Mrs. Vidya M
J.S.S College of Nursing, Mysuru
The Mallory-Weiss syndrome is included within the trauma of the esophagus. It is more common in men and can occur at any age. It is often associated with alcoholism and eating disorders. . Clinically, there is presence of blood after an episode of vomiting (haematemesis) after several attempts to vomit or vomiting. The confirmatory diagnosis is made by means of endoscopy. The prognosis is usually good and in most cases is enough conservative medical treatment.
It was first described by G. Kenneth Mallory and Soma Weiss, in 1929, in alcoholic patients. It is estimated to affect 4 per 100,000 individuals, with higher incidence in men than in women. It is also common in patients with eating disorders. In addition, there is evidence pointing to the existence of hiatal hernia is a predisposing factor.
non-perforating tears at the gastroesophageal mucosa Also of called Mallory-Weiss syndrome or gastroesophageal laceration and hemorrhage syndrome. The Mallory-Weiss syndrome is included within the trauma of the esophagus. It is more common in men and can occur at any age. They have suggested various predisposing and precipitating factors of production lacerations. Thus, its incidence is higher in alcoholics.
It has also been considered typical that bleeding is preceded by situations that increase abdominal pressure: nausea, vomiting, cough, epileptic seizures, cardiac massage, etc. It is also related to the presence of hiatal hernia and acute alcohol intake or salicylates. It is not uncommon to find other associated gastrointestinal lesions that may be the cause of nausea and vomiting. Tears can be single or multiple, small or large. This syndrome is usually manifested by hematemesis, which can range from very mild to massive, but sometimes appears only as manes. Currently the Mallory-Weiss syndrome is the cause of 5 to 10% of the upper digestive tract bleeding.
It is often associated with alcoholism 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, is also a known cause of Mallory-Weiss tear.
Mallory–Weiss syndrome often presents as an episode of vomiting up blood (hematemesis) 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. There won't be any abdominal pain.
Clinically, there is presence of blood after an episode of vomiting (haematemesis) after several attempts to vomit or vomiting productive, but can also be observed blood in the stool (melena),without vomiting history.
The confirmatory diagnosis is made by means of endoscopy, able to point out the characteristic lesion of this syndrome. Furthermore, blood tests, coagulation property test and levels of urea, creatine and electrolytes may be useful for the diagnosis of this disorder
The prognosis is usually good and in most cases is enough conservative medical treatment. Tears usually heal in 10 to 12 days without special treatment. inhibitors of gastric secretion (particularly proton-pump inhibitor) can be administered.  When the bleeding stops are not indicated cauterization or endoscopic photocoagulation. Rarely, surgery is required to sew the tear. Treatment is usually supportive as persistent bleeding is uncommon. However cauterization 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. It is to be noted that the tube will not be able to stop bleeding as here the bleeding is arterial and the pressure in the balloon is not sufficient to overcome the arterial pressure. It is common for bleeding disappears within 24 to 48 hours. However, if bleeding is not staunched spontaneously, some measures can be taken, such as:
· Use of intravenous epinephrine;
· Cauterization of blood vessels;
· Intravenous administration of vasopressin;
· Endoscopic ligation;
· Clipping pressure.
The use of certain drugs can also be useful, such as antacids, antihistamines and anti-emetics. This condition is rarely fatal.
1. Caroli A, Follador R, Gobbi V, Breda P, Ricci G (1989). "[Mallory-Weiss syndrome. Personal experience and review of the literature]". Minerva dietologicae gastroenterologica (in Italian) 35(1): 7–12. PMID 2657497.
3. Parva M, Finnegan M, Keiter C, Mercogliano G, Perez CM (August 2009). "Mallory-Weiss tear diagnosed in the immediate postpartum period: a case report". J Obstet Gynaecol Can 31 (8): 740–3. PMID 19772708.