Mallory-Weiss Tear

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management

Definition

Mallory-Weiss tear is a mucosal tear at the gastro-oesophageal junction, usually caused by forceful vomiting or retching, leading to upper gastrointestinal bleeding.

Aetiology

  • Forceful vomiting or retching: commonly due to excessive alcohol consumption or food poisoning.
  • Severe coughing: associated with respiratory infections.
  • Hiatus hernia: increases susceptibility to mucosal tears.
  • Seizures: forceful diaphragmatic contractions may contribute.
  • Endoscopic procedures: rare iatrogenic cause.

Pathophysiology

  • Sudden increase in intra abdominal pressure (e.g., vomiting) causes a longitudinal mucosal tear at the gastro-oesophageal junction.
  • The tear exposes underlying vessels, leading to bleeding, which is usually self limiting.
  • In severe cases, arterial bleeding can occur, requiring intervention.

Risk factors

  • Excessive alcohol consumption.
  • Gastroenteritis or food poisoning.
  • Hiatus hernia.
  • Severe coughing fits.
  • Pregnancy related hyperemesis gravidarum.
  • Heavy lifting or straining.

Signs and symptoms

  • Haematemesis: vomiting fresh red blood or coffee-ground vomit.
  • Melena: dark, tarry stools in cases of prolonged bleeding.
  • Epigastric pain: often mild or absent.
  • Syncope or dizziness: due to significant blood loss.

Investigations

  • Blood tests:
    • Full blood count (to assess for anaemia).
    • Urea and electrolytes (elevated urea suggests upper GI bleeding).
    • Coagulation profile (if coagulopathy is suspected).
  • Endoscopy (gold standard): confirms diagnosis and assesses severity of bleeding.

Management

1. Initial Resuscitation:

  • ABCDE approach: assess airway, breathing, circulation.
  • IV fluids: crystalloids for volume resuscitation.
  • Blood transfusion: if significant anaemia or haemodynamic instability.
  • Proton pump inhibitors (PPIs): IV omeprazole 40 mg BD to reduce gastric acid and promote healing.

2. Endoscopic Management:

  • most cases resolve spontaneously.
  • Endoscopic haemostasis: required if active bleeding persists, using adrenaline injection, thermal coagulation, or endoclips.

3. Supportive Care:

  • Avoid alcohol and NSAIDs to prevent recurrence.
  • Monitor for recurrent bleeding or complications.
GastroenterologymypanotesMallory-Weiss Tear