Mallory-Weiss syndrome is a disorder in which a person has lacerations or tears in the area where the esophagus and stomach meet. These sometimes heal spontaneously, but sometimes they get complicated.
This is usually caused by episodes of heavy vomiting . The most common is that the lacerations or tears appear a time after several episodes of this class. That is why those who have disorders that include frequent vomiting are more prone.
The Mallory-Weiss syndrome is more common among the elderly , between 40 and 60 years . However, it can also affect adults of other ages, and even children. This condition occurs in both men and women in equal proportion.
General aspects of Mallory-Weiss syndrome
In Mallory-Weiss syndrome, it is usual for lacerations or tears to heal on their own within 7 to 10 days. However, it is also possible that they give rise to more profuse hemorrhages, which sometimes may require surgery. There are some factors that increase the risk of suffering from Mallory-Weiss syndrome. These are:
- Ingestion of large amounts of alcohol.
- Severe liver disease.
- Cough, hiccups or great effort in the bowel movement.
- Hiatal hernia, esophagitis or gastritis.
- Abdominal injury
- Nausea and vomiting during pregnancy.
- Giving birth.
- Use aspirin or similar medications
Up to 25% of patients do not have any of these predisposing factors . In turn, 83% of those who have Mallory-Weiss syndrome have some type of previous abnormality in the gastric mucosa.
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The typical symptom of Mallory-Weiss Syndrome is gastrointestinal bleeding . The normal thing is that it yields spontaneously. If the bleeding is very profuse, it will leave the digestive tract through the mouth or the anus.
In the faeces the blood appears in the form of threads or manes, or completely digested in the feces. In this case, the stools will be black . In vomit, blood rarely shows its typical red color. It looks dark and coagulated. Its appearance is similar to that of ground coffee.
There are other diseases that generate similar symptoms. Among them, Zollinger-Ellison syndrome, chronic erosive gastritis, peptic ulcer, perforation of the esophagus or Boerhaave syndrome.
Mallory-Weiss Syndrome Treatment
As already noted, in most cases the wounds heal without intervention. Normally this occurs between the next 24 and 48 hours, period in which the patient must be under medical observation. Healing occurs between 5 and 10 days later.
In case the bleeding does not stop, it is usual to administer medications to reduce stomach acid . Also to control vomiting and nausea. The effectiveness of the drugs is under debate. If the problem persists, it is usual to follow one of the following two lines of action:
- Endoscopic therapy The options are: 1) Injection therapy. Medications are injected to close the blood vessel and stop bleeding; 2) Coagulation therapy. Heat is applied to seal the vessel that is torn.
- Surgery It is only necessary to do it in the most serious cases, which are a minority. It is done by laparoscopy and the objective is to sew the laceration.
In some cases the patient requires a blood transfusion after these procedures, to compensate for the loss of blood due to the hemorrhage. This occurs in a proportion of 40% to 70% of cases.
Prevention and prognosis
The best way to prevent Mallory-Weiss syndrome is to maintain a healthy and balanced diet. It is also advisable to reduce the consumption of alcohol to a minimum. Any practice tending to cause vomiting should be eliminated.
In general, Mallory-Weiss syndrome does not present complications, except for the consequences of blood loss due to hemorrhage. In 9% of the patients , hemodynamic stability is affected . The mortality rate for this disease is very low.
The clinical outcome of Mallory-Weiss syndrome is usually very positive . However, when there are problems with liver cirrhosis or disorders in blood clotting, the likelihood of having new episodes of bleeding in the future increases significantly.
- Jensen DM. Gastrointestinal hemorrhage and occult gastrointestinal bleeding. In: Goldman L, Ausiello D, eds. Goldman-Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2012: chap 137.
- Katzka DA. Esophageal disorders caused by medications, trauma, and infection. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016: chap 46.
- Kovacs TO, Jensen DM. Gastrointestinal hemorrhage. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016: chap 135
- Caroli A, Follador R, Gobbi V, Breda P, Ricci G (1989). «Mallory-Weiss syndrome. Personal experience and review of the literature. ” Minerva Dietol Gastroenterol. 1989 Jan-Mar; 35 (1): 7-12.