Accounts for 3% to 15% of cases of upper GI bleed. Most occur after a sudden rise in abdominal pressure or transmural pressure gradient across the gastroesophageal junction. This induces a tear and subsequent GI bleeding.
Commonly presents with hematemesis after an episode of forceful or long-term retching, vomiting, coughing, or straining.
Definitive diagnosis is made by esophagogastroduodenoscopy.
Treatment in general is supportive as most cases are self-limited. Emergency treatment is reserved for those showing signs or symptoms of instability.
First-line treatment in an actively bleeding patient is therapeutic endoscopy. Endoscopy is probably the most sensitive and specific diagnostic test for Mallory-Weiss tear (MWT) and can also help to rule out other causes of upper GI bleeding.
In rare cases, angiography with embolization of the arteries supplying the region, or surgical repair may be required to control the bleeding.
Actively bleeding tear appears as a red longitudinal defect with normal surrounding mucosa
From the collection of Juan Carlos Munoz, MD, University of Florida
- postural/orthostatic hypotension
- signs of anemia
1st Tests To Order
- flexible esophagogastroduodenoscopy (EGD)
- cross matching/blood grouping
Other Tests to Consider
- urgent evaluation + monitoring
- endoscopy ± intervention
- antigastric acid therapy pre-endoscopy
- antiemetic pre-endoscopy
- somatostatin analog pre-endoscopy
- erythromycin pre-endoscopy
- surgical intervention or Sengstaken-Blakemore tube