What is Mallory-Weiss Syndrome?
A Mallory-Weiss tear is a tear in the lining of the esophagus, stomach or upper intestines. The tear is most likely to be in one of two places:
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The place where the esophagus (food tube) meets the stomach, or
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In the lining of the upper part of the stomach.
The problem tends to affect people in their 40s and 50s, but it can occur at any age. It is more common in men than women.
What causes it?
The lining of the esophagus or stomach can tear if there is too much pressure on it. Most of the time the cause is forceful or long-term vomiting as a result of:
Less common causes are straining when lifting, violent coughing or hiccuping. It may also be caused by epileptic convulsions. Sometimes there is no known cause.
What are the symptoms?
Most people with this problem vomit bright red blood. This often happen after other retching or vomiting. The amount of blood varies from person to person. Most people vomit just a small amount of blood, but bleeding can be severe.
Stools can become dark black or tarry in color and very smelly. This is less common. In some cases, bright red blood may pass out the rectum.
Some people have pain in their upper abdomen. They may feel dizzy and light-headed because of the blood loss. If bleeding is severe, a person can collapse.
There are many other problems that can cause a person to vomit blood. Bleeding is also a symptom of a stomach ulcer or inflammation of the stomach or esophagus. Mallory-Weiss syndrome is the cause in around 5 out of 100 cases of vomiting blood. If you have any of these symptoms, it is important that you see your doctor right away.
How is Mallory-Weiss syndrome diagnosed?
Your doctor may want you to have a gastroscopy. It may also be called an upper endoscopy.
This test allows a doctor to look at the lining of your esophagus, stomach, and the first part of your small intestine. The doctor uses a narrow, flexible, lighted camera tube called an endoscope. It is about as thick as a little finger.
The endoscope passes through your mouth and enters your esophagus, stomach and intestine. The tip of the endoscope has a light and a tiny video camera. Your doctor can see if you have a Mallory-Weiss tear and its location. He or she can also see if the tear is still bleeding.
In many cases, the bleeding has stopped by the time the test takes place. If so, you may not need treatment. The tear often heals by itself after a few days.
What is the treatment?
The first thing that your doctor will do if he or she suspects Mallory-Weiss syndrome is to make sure that your condition is stable. If you have lost a lot of blood, you might receive fluids by IV. Some people need a blood transfusion. Your health care team will closely watch your blood pressure and pulse rate to check your response to any treatment.
You will most likely have blood tests to check for anemia and to make sure that your blood is clotting normally. You might receive medicine to help prevent nausea or vomiting.
Once your condition is stable, you most likely will have a gastroscopy. What happens next depends on whether the tear is still bleeding. In many cases, the bleeding has stopped by the time gastroscopy takes place.
If the Mallory-Weiss tear is still bleeding
If the tear is still bleeding, treatment to stop the bleeding will occur during the gastroscopy. There are many treatments options. For example:
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A heater probe passes down the side channel of the endoscope to apply heat to the bleeding blood vessels. This stops the bleeding.
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The doctor injects adrenaline (epinephrine) around the bleeding point. This drug causes the bleeding to stop. Again, the side channel of the endoscope is used for this.
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Your doctor can use special metal clips to close the tear and stop the bleeding. This is known as hemoclipping.Sometimes the doctor uses a combination of treatments.
If these treatments do not stop the bleeding, then your doctor may choose to do angiography with embolisation. First, he or she injects a special dye into your bloodstream. Then x-rays are taken. The x-rays show the blood vessels so the doctor can see where the bleeding is coming from. This part is the angiography.
Next the doctor injects a substance into the bleeding blood vessel to close it off. This part is called embolisation.
In rare cases, surgery is needed. If other treatments have failed to stop the bleeding, the surgeon can sew the tear shut.
If the Mallory-Weiss tear has stopped bleeding
If the tear has stopped bleeding by the time you have the gastroscopy, you may not need further treatment. The tear should heal by itself. You might need to stay in the hospital for a while to make sure that bleeding doesn't start again. You might also receive medicine to reduce stomach acid. This will help the tear heal.
What is the outlook for Mallory-Weiss syndrome?
The outlook is generally very good. In up to 9 out of 10 people, the bleeding stops by itself and no treatment is needed. Mallory-Weiss tears usually heal within a few days.
Will this problem come back?
Most people do not have Mallory-Weiss syndrome more than once. However, it can happen again. It is more likely after heavy lifting, violent coughing or a lot of vomiting. You also have more risk if you drink a lot, have cirrhosis of the liver or problems with blood clotting.
When should I call my doctor?
Call your doctor if you vomit blood or if you pass bloody stools.