Mallory-Weiss syndrome is a condition characterized by at least one longitudinal tear in the lining of distal esophagus and/or proximal stomach.
Mallory-Weiss syndrome is thought to develop due to a sudden pressure increase in the abdomen. This often occurs in the setting of vomiting or retching.
Bleeding occurs if the tear involves underlying veins or arteries. Patients usually present with acute onset of gastrointestinal bleeding with vomiting of blood (either red blood or coffee-ground material). The vomiting of blood may be associated with abdominal pain or back pain. Patients often have a history of non-bloody emesis or retching prior to the bloody emesis.
Esophageal perforation (Boerhaave syndrome) occurs if the tear involves the full thickness of the esophagus. This can present with fever, chest pain, and shortness of breath.
An upper endoscopy can establish the diagnosis via visualization of the tear, which is usually located at the gastroesophageal junction where the esophagus connects to the stomach. Because most Mallory-Weiss tears heal quickly on their own, sometimes, tears may not be visualized on upper endoscopy because they have already healed. The upper endoscopy also rules out other etiologies of bleeding and allows for therapeutic treatment of the tear if necessary.
Most Mallory-Weiss tears heal on their own within 24-48 hours. Tears that are actively bleeding or are at high risk for re-bleeding require endoscopic therapy. Tears that are not actively bleeding can be managed with acid suppression alone (i.e. proton pump inhibitor) and antiemetic as needed for patients with persistent nausea or vomiting. If persistent or recurrent bleeding occurs despite endoscopic therapy, treatment by interventional radiology or surgery may be necessary.