Mallory-Weiss Syndrome
Mallory-Weiss Syndrome
Definition
Mallory-Weiss syndrome is bleeding from an arterial blood vessel in the upper gastrointestinal tract, caused by a mucosal gastric tear at or near the point where the esophagus and stomach join.
Description
Mallory-Weiss syndrome causes about 5% of all upper gastrointestinal bleeding. The condition was originally diagnosed in alcoholics and is associated with heavy alcohol use, although it can also be found in patients who are not alcoholics. Earlier episodes of heavy hiccupping, vomiting, and retching are reported by about half the patients who are diagnosed with Mallory-Weiss syndrome. It is thought that the tear or laceration occurs when there is a sudden increase in intra-abdominal pressure. Patients with increased pressure in the vein leading into the liver (portal hypertension ) are more likely to bleed heavily from an esophageal laceration than those whose blood pressure is normal.
Causes and symptoms
In Mallory-Weiss syndrome, a tear occurs in the gastric mucosa, near where the esophagus and stomach join. About 10% of the tears are in the esophagus. Most are either right at the junction of the esophagus and stomach or in the stomach just slightly below the junction.
Bleeding from the tear causes a disruption in fluid and electrolyte balance of the body. The patient often produces vomit tinged with either fresh blood or older, blackish blood. Blood loss can be considerable.
Diagnosis
A Mallory-Weiss syndrome tear is not visible on standard upper gastrointestinal x rays. A tear about one-eighth to one and one-half inches long (0.5-4 cm) is revealed by endoscopy. Endoscopy also shows that in 35% of patients there is another potential cause for gastrointestinal bleeding, such as peptic ulcer, erosive gastritis, or esophageal varices.
Treatment
The patient is resuscitated and stabilized with blood transfusions and intravenous fluids to restore the fluid and electrolyte balance. Most of the time, esophageal bleeding stops spontaneously. When bleeding does not stop, patients are treated with an injection of epinephrine (adrenaline) and/or the bleeding artery is cauterized with heat. If these treatments fail, surgery is performed to stop the bleeding.
Prognosis
In 90-95% of patients whose bleeding does not stop spontaneously, cauterization without surgery will stop the bleeding. Patients at highest risk for a recurrence of bleeding are those with portal hypertension.
Prevention
Mallory-Weiss syndrome is associated with alcoholism. Limiting alcohol intake may help prevent the disorder.
Resources
BOOKS
"Mallory-Weiss Syndrome." In Current Medical Diagnosis and Treatment, 1998. edited by Stephen McPhee, et al., 37th ed. Stamford: Appleton & Lange, 1997.
KEY TERMS
Electrolytes— Salts and minerals that can conduct electrical impulses in the body. Common human electrolytes are sodium chloride, potassium, calcium, and sodium bicarbonate. Electrolytes control the fluid balance of the body and are important in muscle contraction, energy generation, and almost every major biochemical reaction in the body.
Endoscopy— A procedure in which an instrument containing a camera and a light source is inserted into the gastrointestinal tract so that the doctor can visually inspect the gastrointestinal system.
Esophageal varix— An enlarged vein of the esophagus. (Plural: esophageal varices.)
Portal hypertension— High blood pressure in the portal vein, which carries blood from the abdominal organs to the liver.