Mallory–Weiss Syndrome

content of this page

1- Introduction, Definition & Anatomical Location

2- Pathophysiology

3- Risk Factors & Precipitating Events

4- Clinical Presentation (Signs & Symptoms)

5- Differential Diagnosis of Haematemesis

6- Endoscopic Findings

7- Initial Resuscitation

8- Pharmacological & Supportive Treatment

9- Prognosis & Recurrence Risk

Introduction

Mallory–Weiss syndrome is a cause of non-variceal upper gastrointestinal bleeding, characterized by a longitudinal mucosal tear at the gastro-oesophageal junction, typically on the gastric side of the lesser curvature.


–Clinical relevance: Accounts for ~5% of upper GI bleeds.

Pathophysiology

The tear arises due to:

  • A sudden increase in intra-abdominal pressure (e.g. during forceful vomiting or retching)

  • Against a closed lower oesophageal sphincter, creating shear stress

  • Resulting in superficial mucosal laceration, not a full-thickness perforation

Risk Factors & Precipitating Events

Common triggers and associations include:

  • Prolonged retching or vomiting

  • Alcohol binge drinking

  • Hiatus hernia

  • Endoscopy procedures

  • Seizures or blunt abdominal trauma

Clinical Presentation

  • Symptoms:

    • Haematemesis – bright red or coffee-ground vomiting of blood

    • Melaena – black tarry stools (if bleeding persists)

    • Syncope or lightheadedness if bleeding is significant

     

  • Signs:

    • Often unremarkable unless bleeding is severe:

      • Hypotension

      • Tachycardia

      • Pallor

Differential Diagnosis of Haematemesis

  • Peptic ulcer disease → Epigastric pain, NSAID use

  • Oesophageal varices → History of cirrhosis, massive bleeding

  • Boerhaave syndrome → Chest pain, surgical emphysema, shock

  • Gastritis/Gastric erosions → NSAID use, alcohol, mild bleeding

  • Gastric cancer → Weight loss, early satiety, anaemia

Endoscopic Findings

  • Linear mucosal tear at the gastro-oesophageal junction

  • Active bleeding may be seen

  • No ulcer base or varices

  • Endoscopy is both diagnostic and therapeutic

© image from Wikimedia Commons

Initial Resuscitation

Stabilize first!

 

  • ABC approach: Airway, Breathing, Circulation

  • IV fluids (crystalloids) → support perfusion

  • Blood transfusion if anaemia or ongoing bleeding

  • Monitor vital signs, urine output, haemoglobin

  • Crossmatch blood early if severe bleeding is suspected

Pharmacological & Supportive Treatment

  • IV Proton pump inhibitors (PPIs) – e.g. omeprazole

  • Anti-emetics – to control vomiting and prevent re-tear

  • Endoscopic haemostasis:

    • Adrenaline injection

    • Thermal coagulation

    • Mechanical clips

Prognosis & Recurrence Risk

  • Excellent prognosis in most cases

  • Spontaneous resolution in ~80–90%

  • Low recurrence if vomiting is managed

  • Mortality is rare and usually relates to underlying comorbidities

Scroll to Top