Mallory-Weiss tear

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Background

  • Longitudinal lacerations through mucosa and submucosa
  • 75% in proximal stomach, rest in distal esophagus
  • Due to sudden increase in intrabdominal pressure
    • Typically in the setting of forceful vomiting or retching

Clinical Features

Risk Factors

History

  • Classic presentation: Hematemesis following vomiting or retching
    • As few as 30% of patients present this way
  • Coffee ground emesis
  • Melena
  • Hematochezia

Differential Diagnosis

Upper gastrointestinal bleeding

Mimics of GI Bleeding

Evaluation

  • Approach as any GI bleed
    • CBC
    • BMP
    • Type and screen
    • Guiac
    • CXR
  • Definitive diagnosis by endoscopy

Management

  • Most Mallory-Weiss tears are minor and resolve on their own, but up to 3% of upper gastrointestinal bleeding deaths are a result of Mallory-Weiss tears
  • Endoscopy only for active and on-going bleeding[1]
  • Treat as undifferentiated upper GI bleed
    • Many of these patients are alcoholics and have cirrhosis; consider esophageal varices
    • History of vomiting/retching; consider boerhaave

Treatments Not Supported by the Literature

  • No evidence to support octreotide use

Disposition

  • Anticipate admission

See Also

External Links

References

  1. Gyawali CP. The Washington Manual Gastroenterology Subspecialty Consult 2ed. 2008. Washington University School of Medicine.

Authors:

Ross Donaldson