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 can occur with stomach illness, it also frequently occurs due to chronic alcohol abuse or bulimia.
Other conditions can result in a tear of the esophagus, as well. 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
- 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 in 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
- vomiting up blood, which is called hematemesis
- involuntary retching
- bloody or black stools
Blood in the vomit will usually be dark and clotted and may look like coffee grounds. Occasionally it can be red, which indicates it’s fresh. Blood that appears in the stool will be dark and look like tar, unless you have a large bleed, in which case it will be red. If you have these symptoms, seek immediate emergency care. In some cases, blood loss from MWS can be substantial and life-threatening.
There are other health problems that may produce similar symptoms. 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 inflammation of the stomach lining that causes ulcer-like lesions
- perforation of the esophagus
- peptic ulcer
- Boerhaave’s syndrome, which is a rupture of the esophagus due to vomiting
Only your doctor can determine if you have MWS.
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 discomfort during this procedure. Your doctor will insert a small, flexible tube with a camera attached to it, called an endoscope, down your 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. Healing typically occurs in a few days and doesn’t require treatment. But if the bleeding doesn’t stop, you may need one of the following treatments.
You may need endoscopic therapy if the bleeding doesn’t stop on its own. The doctor performing the EGD can perform this therapy. Endoscopic options include:
- injection therapy, or sclerotherapy, which delivers medication to the tear to close off the blood vessel and stop the bleeding
- coagulation therapy, which delivers heat to seal off the torn vessel
Extensive blood loss may require the use of transfusions to replace lost blood.
Surgical and other options
Sometimes, endoscopic therapy isn’t enough to stop the bleeding, so other ways of stopping the bleeding must be used, such as laparoscopic surgery to sew the tear closed. If you can’t undergo surgery, your doctor may use arteriography to identify the bleeding vessel and plug it to stop the bleeding.
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.
To prevent MWS, it’s important to treat conditions that cause long episodes of severe vomiting.
Excessive alcohol use and cirrhosis can trigger recurring episodes of MWS. If you have MWS, avoid alcohol and talk to your doctor about ways to manage your condition to prevent future episodes.