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Mallory–Weiss syndrome

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Mallory–Weiss syndrome
Other namesGastro-esophageal laceration syndrome
Mallory–Weiss tear affecting the esophageal side of the gastroesophageal junction
SpecialtyGastroenterology Edit this on Wikidata

Mallory–Weiss syndrome is a condition where high intraabdominal pressures cause laceration of the mucosa called Mallory-Weiss tears.[1][2] The tears cause upper gastrointestinal bleeding and predominantly occur where the esophagus meets the stomach (gastroesophageal junction).[1] However, the tears can happen anywhere from the middle of the esophagus to the cardia of the stomach.[1] Mallory-Weiss syndrome is often caused by constant vomiting and retching from alcoholism or bulimia.[1] Gastroesophageal reflux disease (GERD) is another risk factor that is often linked with Mallory-Weiss Syndrome.[1] However, not every individual with Mallory-Weiss syndrome will have these risk factors.[1] Individuals with Mallory-Weiss syndrome will have hematemesis, however the symptoms can vary. [1]

Signs and symptoms

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Mallory–Weiss Syndrome often presents as an episode of vomiting up blood (hematemesis) after violent retching or vomiting[3], but may also be noticed as old blood in the stool (melena), and a history of retching may be absent.

In most cases, the bleeding stops spontaneously after 24–48 hours, but endoscopic or surgical treatment is sometimes required. The condition is rarely fatal.[citation needed]

Causes

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It is often associated with alcoholism[4], eating disorders such as bulimia nervosa, and gastroesophageal reflux disease (GERD).[1] It is thought that Mallory-Weiss Syndome can be due to actions that cause sudden increases in intra-abdominal pressure, such as severe vomiting.[1] There is some evidence that presence of a hiatal hernia is a predisposing condition.[5] There is conflicting data suggesting the association between hiatial hernias and Mallory-Weiss Syndrome. In 1989, a study conducted in Japan set out to determine if there was a link to Malory-Weiss Syndrome and hiatal hernias, this study found that hiatial hernias were found in 75% of patients with Mallory-Weiss Syndrome.[6] On the contrary, a case-control study in 2017 found there was no association between hiatial hernias and Mallory-Weiss Syndrome.[5] Forceful vomiting causes tearing of the mucosa at the junction. NSAID abuse is also a rare association.[7] In rare instances some chronic disorders like Ménière's disease that cause long term nausea and vomiting could be a factor.

Additionally, bleeding from Mallory-Weiss tears is often associated with individuals who have a history of portal hypertension.[1]

The tear involves the mucosa and submucosa but not the muscular layer (contrast to Boerhaave syndrome which involves all the layers).[8] Most patients are between the ages of 30 and 50 years, although it has been reported in infants aged as young as 3 weeks, as well as in older people.[9][10] Hyperemesis gravidarum, which is severe morning sickness associated with vomiting and retching in pregnancy, is also a known cause of Mallory–Weiss tear.[11]

Diagnosis

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Definitive diagnosis is by endoscopy of the esophagus and stomach.[12] Proper history taking by the medical doctor to distinguish other conditions that cause haematemesis but definitive diagnosis is by conducting esophagogastroduodenoscopy.[13][14][15]

Treatment

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Treatment is usually supportive as persistent bleeding is uncommon. However cauterization or injection of epinephrine[16] to stop the bleeding may be undertaken during the index endoscopy procedure. Very rarely embolization of the arteries supplying the region may be required to stop the bleeding. If all other methods fail, high gastrostomy can be used to ligate the bleeding vessel. A Blakemore tube will not be able to stop bleeding as here the bleeding is arterial and the pressure in the balloon is not sufficient to overcome the arterial pressure.

History

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Mallory-Weiss Syndrome was named after G. Kenneth Mallory and Soma Weiss who officially characterized the condition as an esophageal laceration in 1929. Before 1929, there were cases reported with similar symptoms of bleeding in the esophagus however those were caused by ulcers and not lacerations. [17]

See also

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References

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  1. ^ a b c d e f g h i j Rawla, Prashanth; Devasahayam, Joe (2024), "Mallory-Weiss Syndrome", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 30855778, retrieved 2024-07-23
  2. ^ Tanabe, S.; Saigenji, K. (1998). "[Mallory-Weiss syndrome]". Nihon Rinsho. Japanese Journal of Clinical Medicine. 56 (9): 2332–2335. ISSN 0047-1852. PMID 9780715.
  3. ^ 1.Lee SH, Yoon C, Chai DG, et al. Mallory-Weiss Syndrome: Retrospective Review of Ten Years’ Experience. Gastrointestinal Endoscopy. 2006;63(5):AB132. doi:https://doi.org/10.1016/j.gie.2006.03.217 ‌
  4. ^ Caroli A, Follador R, Gobbi V, Breda P, Ricci G (1989). "[Mallory–Weiss syndrome. Personal experience and review of the literature]". Minerva Dietologica e Gastroenterologica (in Italian). 35 (1): 7–12. PMID 2657497.
  5. ^ a b Corral, Juan E.; Keihanian, Tara; Kröner, Paul T.; Dauer, Ryan; Lukens, Frank J.; Sussman, Daniel A. (2017-04-03). "Mallory Weiss syndrome is not associated with hiatal hernia: a matched case–control study". Scandinavian Journal of Gastroenterology. 52 (4): 462–464. doi:10.1080/00365521.2016.1267793. ISSN 0036-5521.
  6. ^ Sato, Hiroyuki; Takase, Shujiro; Takada, Akira (1989). "The association of esophageal histus hernia with Mallory-Weiss syndrome". Gastroenterologia Japonica. 24 (3).
  7. ^ R, Eslava García; Jl, Negrete Pardo; P, Muñoz Kim; S, García (April 1990). "[Mallory–Weiss Syndrome. Surgical Treatment After Sclerotherapy. Presentation of a Case and Review of the Literature]". Revista de Gastroenterologia de Mexico. 55 (2): 75–7. PMID 2287873.
  8. ^ Boerhaave Syndrome at eMedicine
  9. ^ Ba¸k-Romaniszyn, L.; Małecka-Panas, E.; Czkwianianc, E.; Płaneta-Małecka, I. (1999-03-01). "Mallory–Weiss syndrome in children". Diseases of the Esophagus. 12 (1): 65–67. doi:10.1046/j.1442-2050.1999.00006.x. ISSN 1120-8694. PMID 10941865.
  10. ^ Kitagawa, Takashi; Takano, Hideya; Sohma, Mitsuhiro; Mutoh, Eiji; Takeda, Shouzo (1994). "Clinical Study of Mallory–Weiss Syndrome in the Aged Patients Over 75 Year. Mainly Five Cases Induced by the Endoscopic Examination". Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics. 31 (5): 374–379. doi:10.3143/geriatrics.31.374. ISSN 0300-9173. PMID 8072208.
  11. ^ Parva M, Finnegan M, Keiter C, Mercogliano G, Perez CM (August 2009). "Mallory–Weiss tear diagnosed in the immediate postpartum period: a case report". J Obstet Gynaecol Can. 31 (8): 740–3. doi:10.1016/S1701-2163(16)34280-3. PMID 19772708.
  12. ^ Hastings, Paul R.; Peters, Kenneth W.; Cohn, Isidore (November 1981). "Mallory–Weiss syndrome". The American Journal of Surgery. 142 (5): 560–562. doi:10.1016/0002-9610(81)90425-6. PMID 7304810.
  13. ^ "Gastroscopy – examination of oesophagus and stomach by endoscope". BUPA. December 2006. Archived from the original on 2007-10-06. Retrieved 2007-10-07.
  14. ^ National Digestive Diseases Information Clearinghouse (November 2004). "Upper Endoscopy". National Institutes of Health. Archived from the original on 2007-10-24. Retrieved 2007-10-07.
  15. ^ "What is Upper GI Endoscopy?". Patient Center -- Procedures. American Gastroenterological Association. Archived from the original on 2007-09-28. Retrieved 2007-10-07.
  16. ^ Gawrieh S, Shaker R (2005). "Treatment of actively bleeding Mallory–Weiss syndrome: epinephrine injection or band ligation?". Current Gastroenterology Reports. 7 (3): 175. doi:10.1007/s11894-005-0030-0. PMID 15913474. S2CID 195343875.
  17. ^ Carr, J. C. (1973-01-01). "The Mallory-Weiss Syndrome". Clinical Radiology. 24 (1): 107–112. doi:10.1016/S0009-9260(73)80127-8. ISSN 0009-9260.
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