Mallory-Weiss syndrome
Mallory-Weiss syndrome is a partial-thickness, longitudinal mucosal tear at the gastroesophageal junction caused by forceful retching or vomiting, classically presenting as hematemesis after an initial bout of non-bloody vomiting in a patient with alcohol use disorder or bulimia. Upper endoscopy is both diagnostic and therapeutic, most tears stop bleeding spontaneously, and active bleeding is controlled endoscopically.
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What this article covers
- Overview
Definition: Mallory-Weiss syndrome is a partial-thickness, longitudinal mucosal and submucosal laceration at or just across the gastroesophageal junction (GEJ), confined to the mucosa and submucosa without breaching the muscularis.
- Epidemiology
Position among UGIB causes: one of the three most common identified causes of UGIB, after peptic ulcer disease (about 50% of cases) and gastroesophageal varices.
- Risk factors
Alcohol use disorder: repeated binge drinking and alcohol-related vomiting is a classic precipitant.
- Pathophysiology
Sudden pressure gradient at the GEJ: forceful retching or vomiting against a closed glottis abruptly raises intragastric and intra-abdominal pressure while the thorax remains relatively negative.
- Clinical features
Hematemesis or coffee-ground emesis after an initial bout of non-bloody vomiting or retching: the hallmark sequence, distinguishing the tear from bleeding that is present from the very first episode of vomiting.
- Differential diagnosis
Boerhaave syndrome (spontaneous esophageal rupture): a full-thickness, transmural tear from forceful vomiting rather than a mucosal-only injury, presenting with severe chest pain, subcutaneous…
- Diagnosis
Established by direct visualization at upper endoscopy: a superficial linear mucosal tear at or straddling the gastroesophageal junction, typically best seen on retroflexed view in the proximal…
- Management
Resuscitate first: intravenous access, crystalloid resuscitation for hemodynamic instability, type and screen, and transfusion of packed red blood cells for significant blood loss or hemoglobin-based…
- Complications
Recurrent or ongoing hemorrhage requiring transfusion or endoscopic retreatment, more likely with a tear that crosses a larger submucosal vessel.
- Prognosis
Excellent in the great majority of patients: bleeding stops spontaneously in about 90% of cases without any endoscopic intervention.
- Prevention
Treat the underlying driver of forceful vomiting: structured alcohol use disorder treatment (counseling plus pharmacotherapy such as naltrexone or acamprosate) for alcohol-related retching, and…
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