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Mallory-Weiss Syndrome

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Mallory-Weiss Syndrome

Mallory-Weiss syndrome is an acute upper gastrointestinal (GI) bleeding disorder caused by
mucosal lacerations at the gastroesophageal junction. The tears may also extend above and/or
below the gastroesophageal junction.

Also called

Gastroesophageal laceration-hemorrhage syndrome

ICD-10

K22.6

Specialty

Gastroenterology

Onset

Acute

Reviewed

July 2026

On This Page

Overview

Mallory-Weiss tears most commonly occur after forceful vomiting, especially in patients with gastric
mucosal injury related to heavy alcohol use. Patients usually present with hematemesis following
episodes of retching or vomiting. Most cases resolve with supportive treatment, while persistent
bleeding may require endoscopic hemostasis.

Etiology & Risk Factors

Common Causes

  • Forceful or repeated vomiting (most common)

  • Severe retching

  • Excessive alcohol intake

  • Persistent coughing

  • Recurrent hiccups

  • Seizures

  • Heavy lifting or straining

  • Blunt abdominal trauma (rare)

  • Upper gastrointestinal endoscopy (rare, iatrogenic)

Risk Factors

  • Heavy alcohol use

  • Recurrent vomiting (e.g., gastroenteritis)

  • Eating disorders (e.g., bulimia nervosa)

  • Pregnancy with hyperemesis gravidarum

  • Hiatal hernia

  • Chronic cough

  • Older age

  • Conditions causing repeated retching or increased intra-abdominal pressure

Pathophysiology

1. Forceful vomiting causes a sudden increase in pressure across the gastroesophageal junction.
2. Longitudinal mucosal lacerations develop at the gastroesophageal junction.
3. The tears bleed, resulting in upper GI hemorrhage.
4. Most bleeding stops spontaneously, but severe hemorrhage can occur.

Clinical Presentation

–Typical features include:
• Hematemesis
• Epigastric pain
• History of forceful vomiting or retching
–Severe cases:
• Hemodynamic instability due to significant blood loss

History Taking

  • Ask about:
    • Recent forceful vomiting or retching
    • Hematemesis
    • Epigastric pain
    • Amount of blood vomited
    • Alcohol use
    • Previous episodes of GI bleeding
    • Symptoms of dizziness or syncope suggesting significant blood loss

Physical Examination

Assess for:
• Signs of upper GI bleeding
• Hemodynamic instability
• Tachycardia
• Hypotension
• Evidence of volume depletion

Investigations

  • Initial Tests

    • Complete blood count (CBC)

    • Blood type and crossmatch (if significant bleeding)

    • Coagulation profile (PT/INR, aPTT)

    • Renal function tests and electrolytes

    • Liver function tests (especially in patients with alcohol-related liver disease)

    Diagnostic Investigation

    Upper Gastrointestinal Endoscopy (EGD) – Gold Standard

    • Gold standard for diagnosis

    • Identifies the mucosal tear at the gastroesophageal junction

    • Determines whether bleeding is active

    • Allows immediate endoscopic treatment if needed

    Additional Investigations

    • CT angiography (rarely, if endoscopy is nondiagnostic and bleeding persists)

    • Catheter angiography for persistent or recurrent bleeding when endoscopic therapy fails

Diagnosis

  • Diagnosis is usually based on:
    • Typical history (forceful vomiting followed by hematemesis)
    • Confirmation with EGD

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Management

  • 1. Initial Stabilization

    • Assess airway, breathing, and circulation (ABC)

    • Establish IV access

    • Fluid resuscitation if needed

    • Blood transfusion for significant blood loss or hemodynamic instability

    2. Medical Therapy

    • Proton pump inhibitors (PPIs)

    • Antiemetics to control nausea and prevent further vomiting

    • Correct any coagulopathy if present

    3. Endoscopic Therapy

    Indicated for active or ongoing bleeding.

    Options include:

    • Endoscopic hemoclip placement

    • Endoscopic band ligation

    • Injection therapy (e.g., epinephrine)

    • Thermal coagulation

    4. Angiographic or Surgical Management

    Reserved for patients with:

    • Persistent bleeding despite endoscopic therapy

    • Recurrent hemorrhage

    • Hemodynamic instability

    Options:

    • Angiographic embolization

    • Surgical repair (rare)

    5. Follow-Up

    • Treat the underlying cause of vomiting or retching

    • Avoid excessive alcohol consumption

    • Avoid NSAIDs when possible

    • Monitor for recurrent bleeding

Complications

• Acute upper GI bleeding
• Hemodynamic instability
• Significant blood loss requiring transfusion

Prognosis

  • Most patients recover with supportive care. Bleeding often stops spontaneously, and further
    treatment is frequently unnecessary in patients without active bleeding.
  • Severe hemorrhage
    generally responds to endoscopic therapy.

Key Points / Clinical Pearls

• Mallory-Weiss Syndrome is a mucosal laceration at the gastroesophageal junction.
• The classic cause is forceful vomiting or retching.
• Heavy alcohol use is a common associated risk factor.
• Hematemesis and epigastric pain are the typical presenting features.
• EGD is the diagnostic test of choice and can provide therapeutic hemostasis.
• Initial management focuses on hemodynamic stabilization.
• Antiemetics and acid suppression are recommended.
• Angiography is considered if endoscopic treatment fails.
• Surgery is rarely necessary