OVERVIEW

What is Mallory-Weiss syndrome?

Mallory-Weiss syndrome, also known as gastroesophageal mucosal tear syndrome, occurs when a sudden increase in intra-abdominal or intragastric pressure—caused by severe retching, vomiting, heavy lifting, coughing, straining during bowel movements, epileptic seizures, or chest compressions—leads to longitudinal mucosal tears in the distal esophagus and cardia. It may be complicated by acute upper gastrointestinal bleeding, which is often self-limiting but can be life-threatening if small arteries are involved.

Is Mallory-Weiss syndrome common?

Mallory-Weiss syndrome accounts for about 5% of acute upper gastrointestinal bleeding cases. With an annual hospitalization rate of approximately 100 per 100,000 for acute upper gastrointestinal bleeding, this means only about 5 out of 100,000 hospitalized patients have Mallory-Weiss syndrome.

What are the types of Mallory-Weiss syndrome?

Mallory-Weiss syndrome is classified into two types based on the presence of upper gastrointestinal bleeding:

• Mallory-Weiss syndrome with bleeding;

• Mallory-Weiss syndrome without bleeding.

SYMPTOMS

What are the manifestations of Mallory-Weiss syndrome?

Mallory-Weiss syndrome typically presents as acute gastrointestinal bleeding following severe vomiting or retching, with or without epigastric pain or back pain. The blood loss is usually minor and self-limiting.

Can Mallory-Weiss syndrome progress to cancer? What is its disease course?

Mallory-Weiss syndrome is caused by physical factors (e.g., increased intra-abdominal or intragastric pressure) leading to mucosal tears. There is currently no evidence that it progresses to cancer. The disease course varies: patients with minor bleeding often experience self-limiting episodes, while those with portal hypertension or coagulation disorders may suffer recurrent bleeding. Hematochezia and hemodynamic instability indicate severe bleeding.

What symptoms should raise suspicion of Mallory-Weiss syndrome?

Mallory-Weiss syndrome should be highly suspected in patients with hematemesis, abdominal pain, or back pain, especially if preceded by activities that increase intra-abdominal pressure (e.g., severe retching, vomiting, heavy lifting, coughing, straining during defecation, epileptic seizures, or chest compressions).

CAUSES

What causes Mallory-Weiss syndrome?

The pathogenesis of Mallory-Weiss syndrome is not fully understood, but it is often caused by a sudden increase in intra-abdominal pressure. Contributing factors include severe retching, vomiting, heavy lifting, coughing, straining during bowel movements, epileptic convulsions, chest compressions, blunt abdominal trauma, and gastroscopy.

Who is at higher risk for Mallory-Weiss syndrome?

Predisposing factors for Mallory-Weiss syndrome include:

• Patients with hiatal hernia: Hiatal hernia has been found in 40%–100% of Mallory-Weiss syndrome cases;

• Chronic heavy alcohol use: Most case series report that 40%–80% of patients with Mallory-Weiss syndrome have a history of alcohol-induced vomiting;

• Older age may also be a risk factor.

DIAGNOSIS

What tests are needed for Mallory-Weiss syndrome?

Blood, urine, stool, and coagulation routine tests, as well as biochemical tests, are required. The most important test is endoscopy, which can not only diagnose the condition but also provide therapeutic intervention.

What diseases should Mallory-Weiss syndrome be differentiated from?

Since many gastrointestinal diseases can cause symptoms similar to Mallory-Weiss syndrome, it needs to be differentiated from reflux esophagitis, infectious esophagitis, drug-induced esophagitis, gastric ulcer, gastric cancer, and esophageal-gastric variceal bleeding.

What are the diagnostic criteria for Mallory-Weiss syndrome?

The diagnosis is based on two points:

• Presence of factors leading to increased intra-abdominal pressure before onset (such as severe retching, vomiting, heavy lifting, coughing, straining during defecation, epileptic seizures, or chest compressions);

• Endoscopic findings of longitudinal tears in the distal esophagus and gastric cardia, with or without bleeding.

TREATMENT

Which department should I visit for Mallory-Weiss syndrome?

Gastroenterology or general surgery.

Does Mallory-Weiss syndrome require treatment?

Mallory-Weiss syndrome requires treatment.

What are the treatment options for Mallory-Weiss syndrome?

Treatment for Mallory-Weiss syndrome primarily includes medication, endoscopic therapy, and other treatments.

• 40%-70% of patients with Mallory-Weiss syndrome bleeding require blood transfusion, but most tears can heal spontaneously.

• The foundational medication is proton pump inhibitors (PPIs), recommended for all patients. Vasopressin may be used in cases of severe or refractory bleeding.

• Endoscopic therapy is the first-line treatment for actively bleeding tears. Endoscopic treatments include epinephrine injection, electrocoagulation, band ligation, and hemostatic clip application. Other treatment methods include esophageal balloon tamponade, angiographic arterial embolization, and surgical intervention.

Can Mallory-Weiss syndrome be completely cured?

Most cases of Mallory-Weiss syndrome can be cured. Patients with risk factors for rebleeding (such as portal hypertension and/or coagulation disorders) are prone to recurrent bleeding within 24 hours. Additionally, some patients with indicators of severe bleeding (hematochezia and hemodynamic instability) may face fatal outcomes.

DIET & LIFESTYLE

What should patients with Mallory-Weiss syndrome pay attention to in their diet?

Patients with Mallory-Weiss syndrome need to abstain from food and water during bleeding, and gradually transition from liquid to semi-liquid and solid foods after bleeding stops. Additionally, alcoholic patients should be informed of the necessity of quitting alcohol.

PREVENTION

Can Mallory-Weiss syndrome be prevented?

Since the pathogenesis of Mallory-Weiss syndrome is not yet fully understood, there is no specific method to prevent its occurrence. In patients with predisposing factors (such as hiatal hernia or chronic alcoholism), behaviors that may increase intra-abdominal pressure (lifting heavy objects, coughing, straining during defecation, etc.) should be avoided as much as possible.