Mallory-Weiss Syndrome: Causes, Symptoms, Diagnosis, Treatment and Prevention

Prolonged, severe vomiting can cause tears in the lining of the esophagus. The esophagus is the tube that connects the throat to the stomach.

Mallory-Weiss syndrome (MWS) is a condition characterized by a break in the mucous membrane, or inner lining, where the esophagus meets the stomach.

Most lacerations heal in 7 to 10 days without treatment, but Mallory-Weiss lacerations can cause significant bleeding. Depending on the severity of the tear, surgery may be necessary to repair the damage.

Causes

The most common cause of MWS is severe or prolonged vomiting . While this type of vomiting can occur with stomach ailments, it also occurs frequently due to chronic alcohol abuse or bulimia.

Other conditions can also lead to a ruptured esophagus.

These include:

  • Trauma to the chest or abdomen.
  • Severe or prolonged hiccups.
  • Severe cough
  • Lift heavy objects
  • Gastritis, which is an inflammation of the stomach lining.
  • Hiatal hernia : which occurs when part of your stomach pushes through part of your diaphragm.
  • Seizures

Receiving cardiopulmonary resuscitation (CPR) can also lead to a ruptured esophagus.

MWS is more common in men than women. It occurs more often in people with alcoholism.

According to the National Organization for Rare Disorders, people between the ages of 40 and 60 are more likely to develop this condition. However, there are cases of Mallory-Weiss tears in children and young adults.

Symptoms

MWS does not always produce symptoms. This is more common in mild cases when lacerations to the esophagus produce only a small amount of bleeding and heal quickly without treatment.

In most cases, however, symptoms will develop. These may include:

  • Abdominal pain.
  • Vomiting blood, which is called hematemesis.
  • Involuntary retching.
  • Bloody or black stools.

Blood in vomit will usually be dark and clotted and may look like coffee grounds. Occasionally it can be red, indicating that it is fresh.

The blood that appears in your stool will be dark and look like tar, unless you have a large hemorrhage, in which case it will be red. If you have these symptoms, seek immediate emergency care.

In some cases, the blood loss from MWS can be substantial and life-threatening.

There are other health problems that can produce similar symptoms. Symptoms associated with MWS can also occur with the following disorders:

  • Zollinger-Ellison syndrome: which is a rare disorder in which small tumors create excess stomach acids leading to chronic ulcers.
  • Chronic erosive gastritis:   which is the inflammation of the stomach lining that causes ulcer-like lesions.
  • Perforation of the esophagus.
  • Peptic ulcer.
  • Boerhaave syndrome, which is a rupture of the esophagus due to vomiting.

Only your doctor can determine if you have MWS.

Diagnosis

Your doctor will ask about any medical problems, including daily alcohol intake and recent illnesses, to identify the underlying cause of your symptoms.

If your symptoms indicate active bleeding into your esophagus, your doctor may do what’s called an esophagogastroduodenoscopy (EGD). You will need to take a sedative and pain reliever to avoid discomfort during this procedure.

Your doctor will insert a small, flexible tube with an attached camera, called an endoscope, down your esophagus and into your stomach. This can help your doctor view your esophagus and identify the location of the laceration.

Your doctor will likely also order a complete blood count (CBC) to confirm the number of red blood cells. Your red blood cell count may be low if you have bleeding from your esophagus. Your doctor will be able to determine if you have MWS based on the findings of these tests.

Treatment

According to the National Organization for Rare Disorders, bleeding that results from lacerations to the esophagus will stop on its own in about 80 to 90 percent of MWS cases.

Healing usually occurs in a few days and does not require treatment. But if the bleeding doesn’t stop, you may need one of the following treatments.

Endoscopic therapy

You may need endoscopic therapy if the bleeding does not stop on its own. The doctor who performs EGD can perform this therapy.

Endoscopic options include:

  • Injection therapy, or sclerotherapy, which delivers drugs to the laceration to close the blood vessel and stop bleeding.
  • Coagulation therapy, which provides heat to seal the torn vessel. Extensive blood loss may require the use of transfusions to replace lost blood.

Surgical and other options

Sometimes endoscopic therapy is not enough to stop the bleeding, so other ways to stop the bleeding must be used, such as laparoscopic surgery to sew the laceration closed.

If you cannot have surgery, your doctor may use an arteriogram to identify the bleeding vessel and cover it to stop the bleeding.

Medication

Medications to reduce stomach acid production, such as famotidine (Pepcid) or lansoprazole (Prevacid), may also be needed.

However, the effectiveness of these drugs is still under debate.

Mallory-Weiss syndrome prevention

To prevent MWS, it is important to treat conditions that cause long episodes of severe vomiting.

Excessive alcohol use and cirrhosis can trigger recurrent episodes of MWS. If you have MWS, avoid drinking alcohol and talk to your doctor about ways to manage your condition to avoid future episodes.