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Mallory-Weiss Syndrome

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Overview

Mallory-Weiss syndrome (MWS) describes non-variceal bleeding due to mucosal tearing at the gastro-oesophageal junction. The tearing involves the mucosa and submucosa, but not the muscular layer. It is caused by severe vomiting and retching, and many patients present with haematemesis. MWS is generally self-limiting in around 80% of patients.

Epidemiology

  • MWS is most common in people aged 30-50 years
  • MWS is more common in men
  • The most common cause of MWS in women of childbearing age is hyperemesis gravidarum

Risk Factors

Risk factors for MWS include conditions predisposing to retching and vomiting:

  • Excessive alcohol consumption
  • Gastroenteritis
  • Hyperemesis gravidarum
  • Bulimia nervosa

Presentation

Patients present with haematemesis following retching or vomiting. Other associated features may be:

Differential Diagnoses

Boerhaave’s syndrome

  • Although both can follow retching or vomiting, Boerhaave’s syndrome is associated with severe retrosternal/epigastric pain following vomiting
  • Subcutaneous emphysema may be present

Oesophageal varices

Peptic ulcer disease

  • Patients may have pain that worsens when eating (suggesting a peptic ulcer), or pain that is relieved when eating (suggesting a duodenal ulcer)
  • Patients may have a history of nausea and vomiting
  • There may be a history of NSAID use

Investigations

Overview

  • Glasgow-Blatchford score:
    • Guides whether the patient is managed as an outpatient or not
  • Upper gastrointestinal (GI) endoscopy:
    • Urgently after resuscitation if the patient is unstable with upper GI bleeding
    • Within 24 hours of admission for all other patients
  • Rockall score after endoscopy:
    • Determines risk of re-bleeding

Management

See Acute Upper Gastrointestinal Bleeding

Prognosis

  • MWS is generally self-limiting in around 80% of patients
  • Bleeding generally stops within 48-72 hours

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