Severe and prolonged vomiting can result in tears in the lining of the esophagus. The esophagus is the tube that connects your throat to your stomach. Mallory-Weiss syndrome (MWS) is a condition marked by a tear in the mucous membrane, or inner lining, where the esophagus meets the stomach. Most tears heal within 7 to 10 days without treatment, but Mallory-Weiss tears can cause significant bleeding. Depending on the severity of the tear, surgery may be necessary to repair the damage.
The most common cause of MWS is severe or prolonged vomiting. While this type of vomiting occurs with illness, it also frequently occurs due to chronic alcohol abuse or bulimia.
Although frequent vomiting typically causes MWS, there are other conditions that can result in a tear of the esophagus. These include:
- trauma to the chest or abdomen
- severe or prolonged hiccups
- intense coughing
- heavy lifting or straining
- gastritis, which is an inflammation of the lining of the stomach
- a hiatal hernia, which occurs when part of your stomach pushes through part of your diaphragm
Receiving cardiopulmonary resuscitation (CPR) can also lead to a tear of the esophagus.
MWS is more common in males than females. 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.
MWS doesn’t always produce symptoms. This is more common in mild cases when tears of 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
- severe vomiting
- vomiting up blood, which is called hematemesis
- involuntary retching
- bloody or black stools
Blood in the vomit will usually be dark and clotted, but occasionally it can be red, which indicates it’s fresh. It will look like coffee grounds. Blood that appears in the stool will be dark and look like tar. If you have these symptoms, seek immediate emergency care. In some cases, blood loss from MWS is substantial and can be life-threatening.
There are other health problems that may produce similar symptoms. Only your doctor can determine if you have MWS.
Symptoms associated with MWS may also occur with the following disorders:
- Zollinger-Ellison syndrome, which is a rare disorder in which small tumors create excess stomach acids that lead to chronic ulcers
- chronic erosive gastritis, which is an inflammation of the stomach lining that causes ulcer-like lesions
- perforation of the esophagus
- a peptic ulcer
- Boerhaave’s syndrome, which is a rupture of the esophagus due to vomiting
Your doctor will ask you about any medical issues, including daily alcohol intake and recent illnesses, to identify the underlying cause of your symptoms.
If your symptoms indicate active bleeding in the esophagus, your doctor may do what is called an esophagogastroduodenoscopy (EGD). You’ll need to take a sedative and a painkiller to prevent any discomfort during this procedure. Your doctor will insert a small, flexible tube with a camera attached to it, called an endoscope, down the esophagus and into the stomach. This can help your doctor see your esophagus and identify the location of the tear.
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 in the esophagus. Your doctor will be able to determine if you have MWS based on the findings from these tests.
According to the National Organization for Rare Disorders, the bleeding that results from tears in the esophagus will stop on its own in about 80 to 90 percent of MWS cases. This typically occurs in a few days and doesn’t require treatment.
You may need surgery if the bleeding doesn’t stop on its own.
Surgical options include the following:
- Injection therapy, or sclerotherapy, delivers medication to the tear to close off the blood vessel and stop the bleeding.
- Coagulation therapy delivers heat to the torn vessel, sealing it off.
- Arteriography identifies the bleeding vessel and plugs it to stop the bleeding.
Extensive blood loss may require the use of transfusions to replace lost blood.
Medications to reduce stomach acid production, such as famotidine (Pepcid) or lansoprazole (Prevacid) may also be necessary. However, the effectiveness of these medications is still under debate.
Recurrent bleeding may result if you have liver problems including cirrhosis, or scarring of the liver. If you have a blood disorder such as hemophilia that prevents your blood from clotting normally, you also may have recurrent bleeding.
It’s important to treat conditions that cause long episodes of severe vomiting to prevent MWS. Excessive alcohol use and cirrhosis can trigger recurring episodes of MWS. Avoid alcohol and talk to your doctor about ways to manage your condition to prevent future episodes.