eMedicine Specialties > Gastroenterology > Esophagus

Mallory-Weiss Tear: Treatment & Medication

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

Treatment

Medical Care

Initial management consists of implementing resuscitative measures as appropriate, performing endoscopy promptly, and triaging patients to intensive care, hospital inpatient, or outpatient management, depending on the severity of bleeding, comorbidities, and risk of rebleeding and complications.

  • Most patients have stopped bleeding at the time of endoscopy.
  • Five to 35% of patients require some form of intervention, mostly endoscopic. Specific endoscopic therapy for actively bleeding MWTs is described in Procedures.
  • Otherwise, supportive care with volume and/or blood replacement, acid suppression (eg, omeprazole), and antiemetic drug therapy (eg, prochlorperazine) is sufficient in most patients presenting with a MWT.

Surgical Care

Surgical oversewing of the tear is reserved for the occasional bleeding case refractory to endoscopic therapy or angiotherapy.

Consultations

  • Interventional vascular radiology: Attempt angiotherapy for bleeding uncontrolled by endoscopic means.
  • Surgical consultation: Surgery may be needed as salvage therapy for failed endoscopic and/or radiologic intervention.

Diet

  • Fasting is restricted to hemodynamically unstable patients and to those who require repeat endoscopic intervention within a short time because of uncertainty regarding the effectiveness of endoscopic therapy or possible complication of the initial therapy.
  • Unless nausea or vomiting is an issue, patients can resume oral intake following endoscopy, starting with a clear- or full-liquid diet and advancing as tolerated to a regular diet within 48 hours.

Medication

An acid suppressant (eg, proton pump inhibitor) or a mucosal protectant (eg, sucralfate) is usually prescribed for 1-2 weeks to accelerate healing, although this practice is of unproven benefit. An antiemetic (eg, prochlorperazine) is useful for controlling nausea and vomiting, common precipitating factors to MWTs.

Gastrointestinal agents

Protect the gastrointestinal lining and promote faster healing of the mucosa.


Sucralfate (Carafate)

Forms a viscous adhesive substance that protects GI lining against pepsin, peptic acid, and bile salts. Used for short-term management of ulcers.

Adult

1 g PO qid

Pediatric

Not established; 40-80 mg/kg/d PO divided q6h suggested

May decrease effects of ketoconazole, ciprofloxacin, tetracycline, phenytoin, warfarin, quinidine, theophylline, and norfloxacin

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in renal failure and conditions that impair excretion of absorbed aluminum

Antiemetic agents

Control precipitating factors of nausea and vomiting in initiating or aggravating the tears.


Prochlorperazine (Compazine)

May relieve nausea and vomiting by blocking postsynaptic mesolimbic dopamine receptors through anticholinergic effects and depressing reticular activating system. In addition to antiemetic effects, it has the advantage of augmenting hypoxic ventilatory response, acting as a respiratory stimulant at high altitude.

Adult

5-10 mg PO/IM tid/qid; not to exceed 40 mg/d
2.5-10 mg IV q3-4h prn; not to exceed 10 mg/dose or 40 mg/d
25 mg PR bid

Pediatric

2.5 mg PO/PR q8h or 5 mg q12h prn, not to exceed 15 mg/d; IV dosing not recommended for children
0.1-0.15 mg/kg/dose IM; change to PO as soon as possible

Coadministration with other CNS depressants or anticonvulsants may cause additive effects; coadministration with epinephrine may cause hypotension

Documented hypersensitivity; bone marrow suppression; narrow-angle glaucoma; severe liver or cardiac disease

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Drug-induced Parkinson syndrome or pseudoparkinsonism occurs quite frequently; akathisia is most common extrapyramidal reaction in elderly patients; lowers seizure threshold; caution with history of seizures

Proton pump inhibitors

Reduce or eliminate acid secretion to allow faster healing of the mucosal tear.


Omeprazole (Prilosec)

Decreases gastric acid secretion by inhibiting parietal cell H+/K+ -ATPase pump. For short-term (4-8 wk) treatment of active benign gastric ulcer and active duodenal ulcer, treatment of H pylori infection in combination with antibiotics, short-term treatment of symptomatic GERD poorly responsive to customary medical treatment, maintenance of healing of erosive esophagitis, and pathological hypersecretory conditions.

Adult

20 mg PO qd/tid

Pediatric

Not established

May decrease effects of itraconazole and ketoconazole; may increase toxicity of warfarin, digoxin, and phenytoin

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Bioavailability may increase in elderly patients


Esomeprazole (Nexium)

S-isomer of omeprazole. Inhibits gastric acid secretion by inhibiting H+/K+ -ATPase enzyme system at secretory surface of gastric parietal cells.

Adult

20-40 mg PO qd for 4-8 wk

Pediatric

Not established

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Symptomatic relief with proton pump inhibitors may mask symptoms of gastric malignancy

More on Mallory-Weiss Tear

Overview: Mallory-Weiss Tear
Differential Diagnoses & Workup: Mallory-Weiss Tear
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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