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.
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.
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.
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.
The diagnosis of Mallory-Weiss syndrome is usually determined by endoscopic examination of the esophagus membrane.
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.
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
For information about clinical trials sponsored by private sources, contact:
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.
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.
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.
Mallory-Weiss Syndrome. emedicine. Last Updated: January 3, 2003. 9pp.
Mallory-Weiss Tear. emedicine. Last Updated: April 16, 2002. 11pp.
Mallory-Weiss Syndrome. nd. 1p.