Mallory-Weiss Syndrome: Tear in Lower Esophagus

By | July 11, 2013
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Mallory-Weiss Syndrome is a condition in which the lower part of esophagus (gullet) gets a tear, usually near the junction between stomach and esophagus. The tear is superficial and involves mucosa and submucosa of esophagus thus nontransmural in nature. This nature of tear differentiates it from Boerhaave Syndrome which involves tear of all the three muscular layers of esophagus. The Mallory-Weiss syndrome is also called as Mallory-Weiss tear.

The Mallory Weiss tear is caused by conditions which creates massive amounts of pressure in lower esophagus like:

  • Retching
  • Vomiting
  • Excessive Coughing

This disease is more common in alcoholics, bulimics(eating disorder) and pregnant females with hyperemesis gravidarum (morning sickness), as they tend to vomit and retch much more than normal population. Hiatal hernia is known to be a predisposing factor for development of Mallory-Weiss tear.

Signs & Symptoms of Mallory-Weiss Syndrome

Unlike other esophageal disorder Mallory Weiss syndrome does not cause pain or difficulty in swallowing. So, this esophageal disorder is quite different from others in terms of signs and symptoms as it does not cause dysphagia or odynophagia. The tear in the lower esophagus results in upper gastrointestinal painless bleeding which may manifest as:

  • Vomiting up blood (hematemesis)
  • Old blood in stool (malena)

Diagnosis of Mallory Weiss Syndrome

Upper Endoscopy: Diagnosis can be made my visual examination of the lower esophagus by an endoscope.

Treatment of Mallory-Weiss Syndrome

Most of the time the vomiting of blood and malena or the actual bleeding resolves on its own in 24-48 hours and requires no direct therapy. If bleeding does not stop or it is in large quantity, local injection (at the site of the tear) of epinephrine or cauterization  might be necessary.

Other methods
Since most of the time it is an arterial bleed balloon is generally not used as the pressure in the balloon is less than the arterial pressure which can not stop the bleeding, arterial embolization might be necessary. The last resort is ligation of the concerned artery via gastrostomy.

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