Mallory–Weiss Syndrome

Mallory–Weiss syndrome, also known as gastro-oesophageal laceration syndrome, refers to bleeding from a laceration in the mucosa at the junction of the stomach and oesophagus. It is typically caused by severe vomiting, which can result from alcoholism, bulimia, or any other condition causing violent vomiting and retching, such as food poisoning.

The condition is characterised by hematemesis (vomiting blood) due to a tear in the mucosa, often referred to as a Mallory–Weiss tear.

Signs and Symptoms

Mallory–Weiss Syndrome most commonly presents as an episode of vomiting up blood (hematemesis) following violent retching or vomiting. However, it can also be noticed as old blood in the stool (melena), and a history of retching may sometimes be absent. In the majority of cases, the bleeding stops spontaneously within 24–48 hours, but in some instances, endoscopic or surgical treatment may be required. The condition is rarely fatal.

Causes

Mallory–Weiss syndrome is often associated with alcoholism and eating disorders. There is evidence suggesting that a hiatal hernia may predispose individuals to the condition. Forceful vomiting causes tearing of the mucosa at the junction of the stomach and oesophagus. NSAID abuse is a rarer association. Chronic disorders like Ménière's disease, which cause long-term nausea and vomiting, can also be factors.

The tear involves the mucosa and submucosa but does not affect the muscular layer, in contrast to Boerhaave syndrome, which involves all the layers of the oesophagus. Most patients are between 30 and 50 years old, but cases have been reported in infants as young as three weeks and in older individuals. Hyperemesis gravidarum, severe morning sickness in pregnancy, is another known cause.

Diagnosis

Definitive diagnosis of Mallory–Weiss syndrome is made via endoscopy of the oesophagus and stomach. A thorough medical history is essential to distinguish this condition from other causes of haematemesis. Esophagogastroduodenoscopy is the key diagnostic procedure to visualise the tear and confirm the diagnosis.

Treatment

Treatment for Mallory–Weiss syndrome is generally supportive, as persistent bleeding is uncommon. During the initial endoscopy, cauterisation or injection of epinephrine may be performed to stop the bleeding. In rare cases, embolisation of the arteries supplying the region may be required.

If these methods fail, high gastrostomy to ligate the bleeding vessel may be necessary. A Blakemore tube is ineffective in stopping the bleeding due to its arterial nature, as the balloon pressure is insufficient to overcome arterial pressure.

History

Mallory–Weiss syndrome was first described in 1929 by G. Kenneth Mallory and Soma Weiss in a study of 15 alcoholic patients.

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Self-assessment MCQs (single best answer)

What is Mallory–Weiss syndrome?

Which of the following is a common cause of Mallory–Weiss syndrome?

What is the primary symptom of Mallory–Weiss syndrome?

Which diagnostic procedure is essential for confirming Mallory–Weiss syndrome?

Mallory–Weiss syndrome is often associated with which of the following conditions?

In which age group is Mallory–Weiss syndrome most commonly seen?

What is the typical outcome of bleeding due to Mallory–Weiss syndrome?

Which of the following treatments might be used during the initial endoscopy for Mallory–Weiss syndrome?

Which medical specialty is primarily concerned with Mallory–Weiss syndrome?

Who first described Mallory–Weiss syndrome in 1929?