eMedicine Specialties > Gastroenterology > Esophagus

Mallory-Weiss Tear: Follow-up

Author: Louis-Michel Wong Kee Song, MD, Assistant Professor, Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic
Contributor Information and Disclosures

Updated: Apr 16, 2008

Follow-up

Further Inpatient Care

  • Patients without risk factors for rebleeding (eg, portal hypertension, coagulopathy), severe bleeding (eg, hematochezia, hemodynamic instability), or active bleeding at endoscopy can be managed conservatively with an extended observation or brief hospitalization period (approximately 24 h). Patients with actively bleeding MWTs should be hospitalized for at least 48 hours. Patients with clinical risk factors for rebleeding (about 10% of cases) and endoscopic stigmata of nonbleeding visible vessel, pigmented protuberance, or adherent clot should be observed for 48 hours. If rebleeding occurs, it usually takes place within that time period. In one study, the presence of shock at initial manifestation and active bleeding at endoscopy were found to be independent risk factors predicting the recurrent bleeding in patients with MWTs.  
    • Monitor vital signs, obtain serial hemoglobin and hematocrit values (q6h initially), watch for clinical signs of rebleeding, correct coagulopathy if possible, and maintain hemodynamic support with fluid and blood replacement.
    • Transfuse, generally, for hemoglobin levels less than 8 g/dL (<10 g/dL for patients with cardiopulmonary disease).
    • Control or eliminate precipitating factors, such as nausea and vomiting.
    • Treat other associated lesions observed endoscopically as appropriate.

Further Outpatient Care

  • Watch for recurrent symptoms or signs of rebleeding.

Inpatient & Outpatient Medications

  • Proton pump inhibitor (eg, omeprazole 20 mg PO qd) or sucralfate (eg, 1 g PO qid) for 1-2 weeks - To reduce injurious factors, such as acid, pepsin, or bile, that impair the healing of the mucosal tear
  • Specific therapy toward precipitating factors responsible for the MWT (eg, antiemetic for nausea and vomiting)

Deterrence/Prevention

  • Recurrence is rare.
  • Counsel patients who have had a MWT on precipitating factors (eg, alcoholic binge, excessive straining and lifting, violent coughing) that may lead to a recurrent MWT.

Complications

  • Complications, such as myocardial ischemia or infarction, hypovolemic shock, and death, usually relate to the acuity and the severity of bleeding and to associated comorbidities. Fortunately, these complications are uncommon with the current standard of care.
  • Perforation or aggravation of bleeding during endoscopic therapy is a potential complication.
  • Organ ischemia and infarction is a potential complication of angiotherapy.

Prognosis

  • Prognosis is generally good. Most patients usually stop bleeding spontaneously, and MWTs tend to heal rapidly (within 48-72 h).

Miscellaneous

Medicolegal Pitfalls

  • Perform endoscopy promptly when indicated. MWTs heal rapidly and may not be readily apparent when endoscopically evaluated 2-3 days later.
  • Endoscopic examination should be thorough, since coexisting lesions are not uncommon. These lesions may be actual or potential bleeding sites or precipitants of the MWT.
 


More on Mallory-Weiss Tear

Overview: Mallory-Weiss Tear
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Treatment & Medication: Mallory-Weiss Tear
Follow-up: Mallory-Weiss Tear
Multimedia: Mallory-Weiss Tear
References
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References

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Further Reading

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Keywords

MWT, gastroesophageal tears, Mallory-Weiss syndrome, Mallory-Weiss lesion, upper gastrointestinal hemorrhage, retching, vomiting, mucosal lacerations, intragastric pressure, gastric prolapse, straining, hiccuping, coughing, primal scream therapy, blunt abdominal trauma, cardiopulmonary resuscitation, iatrogenic tears, portal hypertension, gastroesophageal varices, hiatal hernia

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Contributor Information and Disclosures

Author

Louis-Michel Wong Kee Song, MD, Assistant Professor, Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic
Louis-Michel Wong Kee Song, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Medical Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Medical Editor

Terence David Lewis, MBBS, FRACP, FRCPC, FACP, Program Director, Internal Medicine Residency, & Assistant Chairman, Associate Professor, Department of Internal Medicine, Division of Gastroenterology, Loma Linda University Medical Center
Terence David Lewis, MBBS, FRACP, FRCPC, FACP is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, California Medical Association, Royal College of Physicians and Surgeons of Canada, and Sigma Xi
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Douglas M Heuman, MD, FACP, Director of Hepatology, McGuire Veterans Affairs Medical Center, Professor, Department of Internal Medicine, Division of Gastroenterology, Virginia Commonwealth University School of Medicine
Douglas M Heuman, MD, FACP is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, and American Gastroenterological Association
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Assistant Dean for Medical Curriculum, Associate Professor of Medicine, Division of General Internal Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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