Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 15-19: Benign Esophageal Lesions + Key Features Download Section PDF Listen +++ +++ Essentials of Diagnosis ++ Hematemesis; usually self-limited Prior history of vomiting, retching in 50% Endoscopy establishes diagnosis +++ General Considerations ++ Characterized by a nonpenetrating mucosal tear at the gastroesophageal junction Events that suddenly raise transabdominal pressure, such as lifting, retching, or vomiting, may be contributory Alcoholism is a strong predisposing factor Accounts for ~5% of upper gastrointestinal bleeding + Clinical Findings Download Section PDF Listen +++ +++ Symptoms and Signs ++ History of vomiting, retching, straining in 50% Hematemesis with or without melena +++ Differential Diagnosis +++ OTHER CAUSES OF HEMATEMESIS ++ Hemoptysis Erosive esophagitis Peptic ulcer disease Esophageal or gastric varices Erosive gastritis, eg, nonsteroidal anti-inflammatory drugs, alcohol, stress Portal hypertensive gastropathy Vascular ectasias (angiodysplasias) Gastric cancer +++ RARE CAUSES ++ Aortoenteric fistula Dieulafoy lesion (aberrant gastric submucosal artery) Hemobilia (blood in biliary tree), eg, iatrogenic, malignancy Pancreatic cancer Hemosuccus pancreaticus (pancreatic pseudoaneurysm) + Diagnosis Download Section PDF Listen +++ +++ Laboratory Tests ++ Complete blood count Platelet count Prothrombin time Partial thromboplastin time Serum creatinine Liver enzymes and serologies Type and cross-matching for 2–4 units or more of packed red blood cells Hematocrit is not a reliable indicator of the severity of acute bleeding +++ Diagnostic Procedures ++ Upper endoscopy Diagnostic Identifies a 0.5–4.0 cm linear mucosal tear usually located either at the gastroesophageal junction or, more commonly, just below the junction in the gastric mucosa + Treatment Download Section PDF Listen +++ +++ Surgery ++ Angiographic arterial embolization or operative intervention is required in patients in whom endoscopic therapy fails +++ Therapeutic Procedures ++ Patients are initially treated as needed with fluid resuscitation and blood transfusions Most patients stop bleeding spontaneously and require no therapy Endoscopic hemostatic therapy is employed in patients who have continuing active bleeding Injection with epinephrine (1:10,000), cautery with a bipolar or heater probe coagulation device, or mechanical compression of the artery by application of an endoclip or band is effective in 90–95% of cases + Outcome Download Section PDF Listen +++ +++ Follow-Up ++ None required +++ Complications ++ Persistent bleeding +++ Prognosis ++ Most Mallory-Weiss bleeds stop spontaneously with rapid healing of mucosal tears Persistent or recurrent bleeding most likely in patients with concomitant portal hypertension or coagulopathy +++ When to Admit ++ All patients with significant hematemesis + References Download Section PDF Listen +++ + +Corral JE et al. Mallory Weiss syndrome is not associated with hiatal hernia: a matched case-control study. Scand J Gastroenterol. 2017 Apr;52(4):462–4. [PubMed: 28007004] + +He L et al. The prediction value of scoring systems in Mallory-Weiss syndrome patients. Medicine (Baltimore). 2019 May;98(22):e15751. [PubMed: 31145291]