Severe and prolonged vomiting can result in lacerations (tears) in the lining of the esophagus. Mallory-Weiss syndrome (MWS) is a tear in the mucous membrane (inner lining) where the esophagus meets the stomach. Most tears heal within a few days without treatment; however, Mallory-Weiss tears can cause significant bleeding. Depending on the severity of the laceration, surgery may be required to repair the damage.
The most common cause of MWS is severe or prolonged vomiting. While this type of vomiting is associated with illness, it also frequently occurs due to chronic alcoholism or bulimia.
Although frequent vomiting typically causes MWS, there are other conditions that can result in a laceration of the esophagus, including:
- trauma to the chest or abdomen
- severe or prolonged hiccups
- intense coughing
- intense snoring
- heavy lifting or straining
- gastritis (inflammation of the lining of the stomach)
- hiatus hernia (when part of your stomach pushes through part of your diaphragm)
- receiving cardiopulmonary resuscitation (CPR)
MWS is more common in males than in females, and occurs more often in people with alcoholism. According to the National Organization for Rare Disorders, individuals between the ages of 40 and 60 are more likely to develop this condition, but cases of Mallory-Weiss tears have been reported in children and young adults (NORD, 2008).
MWS does not always produce symptoms. This is more common in mild cases, when lacerations 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 blood (a condition called “hematemesis”)
- involuntary retching
- bloody stool
Blood in the vomit will be dark and clotted, and will have the appearance of coffee grounds. Blood that appears in the stool will be dark and will have the appearance of tar. If you experience these symptoms, seek immediate emergency care. In some cases, blood loss from MWS is substantial, and can be life threatening.
Although the signs of MWS may indicate the presence of the condition, 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 (a rare disorder in which small tumors create excess stomach acids, which in turn cause chronic ulcers)
- chronic erosive gastritis (inflammation of the stomach lining that causes ulcer-like lesions)
- perforation of the esophagus
- peptic ulcer
- Boerhaave’s syndrome (rupture of the esophagus due to vomiting)
Diagnosis of MWS is made by your doctor during a complete physical exam. 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 an esophagogastroduodenoscopy (EGD). Before this procedure, you will be given a sedative and a painkiller to prevent any discomfort. An endoscope (small, flexible tube with a camera attached to it) will be inserted through the esophagus and into the stomach. This can help your doctor view the esophagus and identify the location of the tear.
A complete blood count (CBC) may also be ordered to confirm low hematocrit (number of red blood cells). Your red blood cell count may be low if you have bleeding in the esophagus. Based on the findings from these tests, your doctor will be able to determine if you have MWS.
In 80 to 90 percent of MWS cases, the bleeding that results from tears in the esophagus will stop on its own. This typically occurs in a few days and will not require treatment (NORD, 2008).
If the bleeding does not stop on its own, surgery may be needed.
Surgical options include:
- injection therapy to deliver medication to the tear to close off the blood vessel and stop the bleeding
- coagulation therapy to deliver heat to the torn vessel, sealing it off
- arteriography to identify the bleeding vessel and plug 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 used. However, the usefulness of these medications has not been proven.
Recurrence and Prevention
Recurrent bleeding may result if you have liver problems (including cirrhosis, or scarring of the liver) or if you have a blood disorder (such as hemophilia) that prevents your blood from clotting normally.
To prevent MWS, it is important to treat conditions that cause prolonged episodes of severe vomiting. Excessive alcohol use and cirrhosis of the liver can trigger recurring episodes of MWS. Avoid alcohol, and talk to your doctor about ways to manage your condition to prevent future episodes.