Mallory-Weiss tear

Answer 1

Definition

A Mallory-Weiss tear occurs in the mucous membrane of the esophagus, where it connects to the stomach. The tear may bleed.

Alternative Names

Mucosal lacerations - gastroesophageal junction

Causes, incidence, and risk factors

Mallory-Weiss tears do not happen very often. They are usually caused by forceful or long-term vomiting or coughing. They may also be caused by epileptic convulsions.

The tear may be followed by vomiting bright red blood or by passing blood in the stool. Any condition that leads to violent and lengthy bouts of coughing or vomiting can cause these tears.

Symptoms

• Bloody stools
• Vomiting blood(bright red)

Signs and tests

• CBC possibly showing low hematocrit
• EGD (esophagogastroduodenoscopy) showing a tear with bleeding

Treatment

The tear usually heals in about 10 days without treatment. Surgery is rarely required. Drugs that suppress stomach acid (proton pump inhibitors or H2 blockers) may be given, but it is not clear if they are helpful.

If blood losshas been great, blood transfusions may be necessary. Excessive bleeding may need to be treated by using an endoscope (see EGD). In most cases, bleeding stops without treatment within a few hours.

Expectations (prognosis)

Repeated bleeding is uncommon unless there is also a problem with blood clotting. The outcome is expected to be good.

Complications

Hemorrhage (loss of blood)

Calling your health care provider

Call your health care provider if you begin vomiting blood or if you pass bloody stools.

Prevention

Treatments to relieve vomiting and coughing may reduce risk. Avoid excessive alcohol use.

ReferencesBjorkman DJ. Gastrointestinal hemorrhage and occult gastrointestinal bleeding. In: Goldman L, Ausiello D, eds.Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 137.

Answer 2

Definition

A Mallory-Weiss tear occurs in the mucus membrane of the lower part of the esophagus or upper part of the stomach, near where they join. The tear may bleed.

Alternative Names

Mucosal lacerations - gastroesophageal junction

Causes, incidence, and risk factors

Mallory-Weiss tears are usually caused by forceful or long-term vomiting or coughing. They may also be caused by epileptic convulsions, or anything else that increases the pressure inside the abdomen.

Any condition that leads to violent and lengthy bouts of coughing or vomiting can cause these tears.

Symptoms

• Bloody stools
• Vomiting blood(bright red)

Signs and tests

• CBC possibly showing low hematocrit
• Esophagogastroduodenoscopy(EGD), more likely to be done when there is active bleeding

Treatment

The tear usually heals in a few days without treatment. Surgery is rarely needed. Drugs that suppress stomach acid (proton pump inhibitors or H2 blockers) may be given, but it is not clear if they are helpful.

If blood losshas been great, blood transfusions may be needed. In most cases, bleeding stops without treatment within a few hours.

Expectations (prognosis)

Repeated bleeding is uncommon and the outcome is usually good. Cirrhosis of the liver and problems with blood clotting make future bleeding episodes more likely to occur.

Complications

Hemorrhage (loss of blood)

Calling your health care provider

Call your health care provider if you begin vomiting blood or if you pass bloody stools.

Prevention

Treatments to relieve vomiting and coughing may reduce risk. Avoid excessive alcohol use.

References

Bjorkman DJ. Gastrointestinal hemorrhage and occult gastrointestinal bleeding. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 137.

Katzka DA. Esophageal disorders caused by medications, trauma, and infection. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier;2010:chap 45.

Reviewed By

Review Date: 11/11/2010

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.