Mallory-Weiss Syndrome: Causes, Symptoms, Diagnosis, Treatment, Prognosis

What Is Mallory-Weiss Syndrome?

Mallory-Weiss syndrome is the name given to a pathological condition in which there is a tear in the lining of the esophagus, which may occur due to persistent and severe vomiting episodes. This tear takes place in the innermost lining of the esophagus where the esophagus meets the stomach. Majority of such tears tend to heal within a few days, but some type of tears tend to cause significant bleeding and for such tears surgical procedure may be required to repair it.

Mallory-Weiss Syndrome

What Are The Causes Of Mallory-Weiss Syndrome?

The root cause of Mallory-Weiss tear is prolonged and persistent vomiting episodes. Such vomiting episodes usually occur due to some type of illness, but may also occur with alcohol abuse or a medical condition called bulimia in which an individual is prone towards overeating. Even though vomiting is the primary cause of Mallory-Weiss tears, there are certain other illness that may also cause this condition. Some of the conditions causing Mallory-Weiss tears are:

  • Any sort of traumatic injury to the chest or abdomen
  • Severe persistent episodes of hiccups
  • Severe coughing
  • Persistent snoring
  • Activities like heavy lifting
  • Gastritis
  • Hiatal hernia
  • Convulsions.

Mallory-Weiss Syndrome is found usually in males and that too in males who chronically abuse alcohol.

What Are The Symptoms Of Mallory-Weiss Syndrome?

Some of the symptoms of Mallory-Weiss Syndrome are

  • Pain in the abdomen
  • Severe and persistent vomiting episodes
  • Hematemesis
  • Persistent retching
  • Blood in the stools.

The blood present in the vomitus will be dark colored, called as coffee ground emesis. Blood in the stool will be dark and tarry. An individual needs emergent medical attention in case he or she experiences these symptoms.

How Is Mallory-Weiss Syndrome Diagnosed?

In order to diagnose Mallory-Weiss Syndrome, the treating physician will take a detailed history and conduct a physical examination. The treating physician will also inquire about whether the individual has a history of chronic alcohol intake. If Mallory-Weiss Syndrome is suspected, the physician will do some tests to confirm the diagnosis.

To begin with, the physician may perform an esophagogastroduodenoscopy to identify any active bleeding in the esophagus. In this procedure, an endoscope is inserted through the esophagus into the stomach, so that the physician is able to visualize the entire esophagus with the help of the camera attached to the endoscope. This is extremely helpful in identifying the precise location of the tear.

A CBC may also be done to look for signs of blood loss. If significant blood loss is present it will be reflected in the hematocrit count of the individual. These two tests confirm the diagnosis of Mallory-Weiss Syndrome.

What Are The Treatments For Mallory-Weiss Syndrome?

To begin with, the treating physician stabilizes the individual suspected to have Mallory-Weiss Syndrome. Intravenous fluid may be administered in case of acute blood loss. In some cases, the individual may also need transfusion of blood due to acute blood loss. Close monitoring of blood pressure and pulse is done. The next thing done is to conduct a blood test to look for hematocrit count in order to identify any anemia due to blood loss and also to look at the clotting factor. Antiemetics may be given to control vomiting episodes.

Once stabilized, the individual is then sent for a procedure called gastroscopy to identify the precise location of the bleeding and to repair it. In majority of the cases, the bleeding caused due to Mallory Weiss Syndrome stops by the time gastroscopy is conducted. Treatment for Mallory Weiss Syndrome depends on whether there is active bleeding at the time of gastroscopy or not.

In cases of active bleeding, the priority is to stop the bleeding first. For this there are a number of different options. The tear can be repaired by utilizing metallic clips so as to close the tear and stop the bleeding. Another method to stop the bleeding is to ligate the vessel thus shutting it off and stopping the bleeding. Another method to stop the bleeding is to apply heat to the bleeding vessel and thus stopping the bleeding. A heater probe is usually used for this purpose. An epinephrine injection directly at the site of bleeding can also stop the bleeding. In most of the cases, bleeding is stopped by these above mentioned treatments.

It is extremely rare that the bleeding due to Mallory Weiss Syndrome does not stop with the above mentioned measures. In cases where the bleeding does not stop, then the bleeding vessel may need to be embolized in order to stop the bleeding. For embolization procedure to be done, it is imperative to perform an angiography first in order to identify the precise location of bleeding. For doing an angiography, a contrast dye is first injected and then x-rays are taken. These specialized x-rays confirm the exact location of the bleeding. After identifying the exact location of the bleeding, a medication is injected to clot the blood and stop the bleeding. This procedure is called embolization.

In situations where bleeding stops on its own, then no particular treatment is required and the tear heals on its own accord. The affected individual may be hospitalized for some time for observation and if bleeding does not recur then he or she is discharged. The individual may be given medications for stomach acid suppression to facilitate healing of the tear

What Is The Overall Prognosis For Mallory-Weiss Syndrome?

The overall prognosis for Mallory Weiss Syndrome is quite good. In majority of cases, the bleeding stops on its own and no particular treatment is required and the tear heals on its own accord in a few days.

What Are The Chances Of Mallory-Weiss Syndrome Recurring?

It is rare for Mallory-Weiss Syndrome to recur; however, the likelihood of it recurring in individuals who have had a history of such a tear in the past is more, especially after heavy strenuous activities, severe coughing episodes etc. If the individual had severe bleeding before, the risk for a retear again is more in such cases.

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:January 11, 2019

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