Mallory Weiss Syndrome

Resumen

Mallory-Weiss syndrome refers to a tear or laceration of the mucous membrane, most commonly at the point where the esophagus and the stomach meet (gastroesophageal junction). Such a tear may result in severe bleeding from the gastrointestinal tract. The immediate cause of the lesion is usually a protracted period of vomiting.

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Sinónimos

Gastroesophageal Laceration-Hemorrhage
Mallory-Weiss Laceration
Mallory-Weiss Tear

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Signos y Síntomas

Mallory-Weiss syndrome is most commonly characterized by abdominal pain, a history of severe vomiting, vomiting of blood (hematemesis), and the strong involuntary effort to vomit (retching). The blood is often clotted and has the appearance of «coffee grounds». The stools may be as dark as tar (melenic). In cases in which there is substantial loss of blood, there may be shock and collapse.

Individuals with Mallory-Weiss syndrome may also experience severe, painless internal gastrointestinal bleeding (hemorrhaging) due to the tears in the mucous membranes. In most cases (80-90%) however, such bleeding ceases spontaneously. In very rare cases, the bleeding may become life-threatening.

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Causas y Herencia

In most instances, the immediate cause of Mallory-Weiss syndrome is severe vomiting. This can be associated with chronic alcoholism, but MWS may also result from a severe trauma to the chest or abdomen, chronic hiccups, intense snoring, lifting and straining, inflammation of the lining of the stomach (gastritis) or esophagus (esophagitis), hiatus hernia, convulsions or CPR (cardiopulmonary resuscitation). Cancer patients undergoing chemotherapy may develop this disorder as a complication of chemotherapy.

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Frecuencia

Mallory-Weiss syndrome accounts for 1 to 15% of all gastrointestinal bleeding episodes. However, it occurs more frequently in individuals with alcoholism. MWS appears to affect more males then females. The ages of those affected varies considerably, with a peak at ages 40 through 60. However, some cases have been reported in children.

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Enfermedades con síntomas similares

Symptoms of the following disorders can be similar to those of Mallory-Weiss Syndrome. Comparisons may be useful for a differential diagnosis:

Zollinger-Ellison Syndrome is a rare disorder characterized by small tumors (usually in the pancreas) which secrete a hormone that produces excess amounts of stomach acids that cause ulcers. These tumors can also appear in the lower stomach wall, spleen or lymph nodes close to the stomach. Large amounts of gastric acid can be found in lower stomach areas where many ulcers form. Ulcers can appear suddenly even in areas where they are rarely found, may persist following treatment, and can be accompanied by diarrhea. Prompt medical treatment of these ulcers is necessary to prevent complications such as bleeding and perforation. (For more information on this disorder, choose «Zollinger» as your search term in the Rare Disease Database.)

Chronic Erosive Gastritis is a common inflammation of the stomach characterized by multiple lesions in the mucous lining, causing ulcer-like symptoms. These symptoms may include a burning and heavy feeling in the pit of the stomach, mild nausea, vomiting, loss of appetite and weakness. In severe cases there can be bleeding of the stomach which may result in anemia. Some people with this disorder, especially chronic aspirin users, may show no apparent symptoms until the disease has advanced. An accurate diagnosis can be made by a physician’s visual inspection of the stomach using a gastroscope. (For more information on this disorder, choose «Gastritis, Chronic Erosive» as your search term in the Rare Disease Database.)

Boerhaave’s Syndrome is a very serious disorder that is characterized by a rupture of the esophagus. It usually occurs from severe vomiting after excessive eating. Those with this disorder may have severe stomach and chest pain, shortness of breath (dyspnea), rapid heartbeat (tachycardia), a blue discoloration of the skin (cyanosis) and eventually circulatory failure due to the loss of blood (shock) through the esophagus. Surgery is usually required to repair this type of rupture. It is important that this disorder be diagnosed promptly so that medical treatment may be administered as soon as possible.

Esophagus Perforation is a rupture of the esophagus. When the rupture occurs in the throat area there may be swelling of the neck and continuous pain that extends from the chest to the back. If it occurs in the chest, there may be vomiting, upper abdominal pain, shortness of breath (dyspnea), and severe chest pain. This disorder can be caused by chemical burns in the throat, complications due to an inflammation of the esophagus (esophagitis), peptic ulcer, or an abnormal growth (neoplasm). Diagnostic medical procedures such as endoscopy or gastroscopy can also cause perforation of the esophagus.

Peptic Ulcer is a very common disorder characterized by lesions of the mucous membranes of the esophagus, stomach or duodenum. These lesions are caused by an over-secretion of acid or pepsin and are characterized by pain, heartburn, nausea and vomiting.

Esophageal Varices are dilated, enlarged, and tortuous veins, arteries or lymphatic vessels at the lower end of the esophagus as a result of portal hypertension; they are superficial and liable to ulceration and massive bleeding.

The following disorder may be associated with Mallory-Weiss Syndrome. It is not necessary for a differential diagnosis:

Chronic hiccups are sudden, involuntary repeated spasms of the diaphragm. They can last for hours or days, or they recur very often with only a few hours relief between spasms. The persistence of hiccups may indicate a serious illness. Some of the illnesses that include persistent hiccups as a symptom are: pleurisy of the diaphragm, pneumonia, uremia, alcoholism, disorders of the stomach or esophagus, and bowel diseases. Hiccups may also be associated with pancreatitis, pregnancy, bladder irritation, liver cancer, hepatitis, surgery, tumors, lesions and gastroesophageal tears. (For more information on this disorder, choose «Hiccups» as your search term in the Rare Disease Database.)

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Diagnóstico

The diagnosis of Mallory-Weiss syndrome is usually determined by endoscopic examination of the esophagus membrane.

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Tratamiento

Treatment

In many cases, bleeding caused by Mallory-Weiss syndrome will stop without treatment. In cases where the bleeding persists, treatment may include sealing the lesion by applying heat or chemicals (cauterization) or high frequency electrical current (electrocoagulation). Blood transfusions and/or the use of the vasopressive drug, pitressin, may be required. (Among other actions, the hormone pitressin acts upon the muscles of the capillaries to affect blood pressure.. Direct pressure may also be used by inserting a catheter which is surrounded by a balloon. The balloon is then inflated (balloon tamponade) to stop the bleeding. Surgery is usually not necessary unless the bleeding cannot be controlled by conservative measures. Other treatment is symptomatic and supportive.

Embolization may be necessary as a treatment for massive uncontrolled bleeding of the esophagus. This procedure consists of inserting a substance, such as gelfoam, bucrylate, or alcohol (ethanol) and stainless steel coils into the affected area.

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Investigaciones

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222

TTY: (866) 411-1010

Email: [email protected]

For information about clinical trials sponsored by private sources, contact:

www.centerwatch.com

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Referencias

TEXTBOOKS

Beers MH, Berkow R., eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:234.

Berkow R., ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:710.

Yamada T, Alpers DH, Owyang C, et al. Eds. Textbook of Gastroenterology. 2nd ed. J. B. Lippincott Company. Philadephia, PA; 1995:1295-96.

Sleisinger MH, et al. Eds. Gastrointestinal Disease. 4th ed.W.B. Saunders Company. Philadelphia, PA; 1989:410.

REVIEW ARTICLES

Church NI, Palmer KR. Ulcers and nonvariceal bleeding. Endoscopy. 2003;35:22-26.

Yamamoto N, Nakamura M, Tachibana S, et al. Evaluation of endoscopic hemostais in upper gastrointestinal bleeding related Mallory-Weiss syndrome. Surg Today. 2002;32:519-22.

Yunes Z, Johnson DA. The spectrum of spontaneous and iatrogenic esophageal injury: perforations, Mallory-Weiss tears, and hematomas. J Clin Gastroenterol. 1999;29:306-17.

JOURNAL ARTICLES

Fujii H, Suehiro S, Shibata T, et al. Mallory – weiss tear complicating intraoperative transesophageal echocardiography. Circ J. 2003;32:233-34.

Morales P, Baum AE. Therapeutic Alternatives for the Mallory-Weiss Tear. Curr Treat Options Gastroenterol. 2003;6:75-83.

Chung IK, Kim EJ, Hwang KY, et al. Evaluation of endoscopic hemostasis in upper gastrointestinal bleeding related to Mallory-Weiss syndrome. Endoscopy. 2002;34:474-79.

Huang SP, Wang HP, Lee YC, et al. Endoscopic hemoclip placement and epinephrine injection for Mallory-Weiss syndrome with active bleeding. Gastrointest Endosc. 2002;55:842-46.

Ganeshram KN, Harrisson P. Two case of submucosal haematoma of the oesophagus and Mallory-Weiss tear. Int J Clin Pract. 2002;56:225-26.

Gunay K, Cabioglu N, Barbaros U, et al. Endoscopic ligation for patients with active bleeding Mallory-Weiss tears. Surg Endosc. 2001:15:1305-07.

Llach J, Elizalde JI, Guevara MC, et al. Endoscopic injection therapy in bleeding Mallory-Weiss syndrome: a randomized controlled trial. Gastrointest Endosc. 2001;54:679-81.

Kortas DY, Haas LS, Simpson WG, et al. Mallory-Weiss tear:predisposing factors and predictors of a complicated course. Am J Gastroenterol. 2001;96:2863-65.

Twerada R, Ito S, Akama F, et al. Mallory-weiss syndrome with severe bleeding: treatment by endoscopic ligation. Am J Emerg Med. 2000;18:812-15.

FROM THE INTERNET

Mallory-Weiss Tear. MedlinePlus. Medical Encyclopedia. Update date: 1/13/2003. 3pp.

www.nlm.nih.gov/medlineplus/ency/article/000269.htm

Mallory-Weiss Syndrome. emedicine. Last Updated: January 3, 2003. 9pp.

www.emedicine.com/ped/topic1359.htm

Mallory-Weiss Tear. emedicine. Last Updated: April 16, 2002. 11pp.

www.emedicine.com/med/topic3428.htm

Mallory-Weiss Syndrome. nd. 1p.

www.cedars-sinai.edu/5687.html

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