Mallory–Weiss syndrome is a condition where high intra-abdominal pressures causes laceration and bleeding of the mucosa called Mallory-Weiss tears.
[1] Additionally, Mallory–Weiss syndrome is one of the most common causes of acute upper gastrointestinal bleeding, counting of around 1-15% of all cases in adults and less than 5% in children.
The tears can cause upper gastrointestinal bleeding and predominantly occur where the esophagus meets the stomach (gastroesophageal junction).
[4][3] Mallory–Weiss syndrome was named after G. Kenneth Mallory and Soma Weiss who accurately characterized the condition as a lower esophageal laceration in 1929 in 15 patients afflicted with alcoholism who presented with signs and symptoms of vomiting and retching.
[3] Years later, Weiss and Mallory performed autopsies on 4 patients that died due to the complications of the syndrome caused by the hemorrhage.
The following year, Hardy per the recommendations of Palmer and Decker was able to complete the first diagnosis of the syndrome via endoscopy, leading to an increased incidence of Mallory–Weiss syndrome as shown with over 200 cases being mentioned in the literature as of 1973,[3] and eventually the standard to make use of endoscopy to diagnosis the condition to witness lacerations along the esophageal lining and the signs of hemorrhage.
This decrease in intravascular volume causes subsequent reflex mechanism produced by the body to activate SANs (sympathetic nervous system) in the later stages of hypovolemic shock.
The causes of Mallory–Weiss syndrome is often associated with alcoholism,[13] eating disorders such as bulimia nervosa,[14] and gastroesophageal reflux disease (GERD).
Additionally, the use of NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen, are known to increase the risk of upper gastrointestinal bleeding.
[18] NSAIDs can increase the risk of upper gastrointestinal bleeding because they can cause further damage to the intestinal submucosa by inhibiting prostaglandin synthesis.
[19] In rare instances some chronic disorders like Ménière's disease that cause long term nausea and vomiting could be a factor.
[20] Additionally, bleeding from Mallory-Weiss tears is often associated with individuals who have a history of portal hypertension and esophageal varices.
[25][26] Hyperemesis gravidarum, which is severe morning sickness associated with vomiting and retching in pregnancy, is also a known cause of Mallory–Weiss tear.
[27] There have been a few complications from invasive procedures such as trans-esophageal echocardiography and upper gastrointestinal endoscopy that cause Mallory-Weiss tears called iatrogenic Mallory–Weiss syndrome.
[2][31] Proper history taking by the medical doctor to distinguish other conditions that cause haematemesis but definitive diagnosis is by conducting esophagogastroduodenoscopy, which is a procedure that allows the oropharynx, esophagus, stomach, and proximal duodenum (beginning of the small intestine) to be visualized.
If the bleeding is mild and localized, the condition can be managed with conservative treatment methods such as intravenous antacids, antiemetics, fasting, and bedrest.
[1][10] Four examples of endoscopic hemostasis techniques are hemoclipping, heat probe thermocoagulation, injection therapy, and band ligation.
However, it should be avoided in patients with esophageal varices as the absence of a serosal layer in the esophagus increases susceptibility to perforation and could exacerbate bleeding, posing significant risks.
[40] Some other options to stop bleeding include ethanol injections, ε-aminocaproic acid,[42] or Argon plasma coagulation (APC).
[12] In pharmacological treatment, proton pump inhibitors (such as omeprazole, pantoprazole) and H2 receptor antagonist (such as famotidine) are utilized to manage and lower gastric acidity.
[2] Proton pump inhibitors are preferred over H2 receptor antagonists because they are more potent and can keep gastric pH under control for a longer period of time.
[43] Furthermore, proton pump inhibitors have a decreased recurrent bleeding rate and do not lose their efficacy as a side effect when taken regularly over time (tachyphylaxis) compared to H2 receptor antagonists.