Mallory-Weiss Syndrome Clinical Presentation

  • Author: Carmen Cuffari, MD; Chief Editor: Carmen Cuffari, MD   more...
 
Updated: Mar 8, 2010
 

History

Presenting symptoms of Mallory-Weiss syndrome include hematemesis, melena, light-headedness, dizziness, syncope, and abdominal pain.

  • Hematemesis: Hematemesis is the presenting symptom in all patients diagnosed with a Mallory-Weiss tear.[5] The diagnosis does not depend on the amount of hematemesis because it can vary from blood flecks or streaks of blood mixed with gastric contents or mucus to several ounces of bright red bloody emesis. In most children, hematemesis is preceded by one or more episodes of nonbloody emesis; however, hematemesis secondary to a Mallory-Weiss tear has been reported to occur during the first bout of vomiting.
  • Melena: Melena has been reported to occur in as many as 10% of patients who have been diagnosed with a Mallory-Weiss tear.
  • Light-headedness, dizziness, or syncope: Patients with severe vomiting can develop light-headedness or dizziness. These symptoms usually occur secondary to dehydration from the underlying cause of vomiting and are not secondary to blood loss from the Mallory-Weiss tear. Only in rare cases does a Mallory-Weiss tear lead to anemia requiring transfusions.
  • Abdominal pain, dyspepsia: As many as 40% of patients may experience epigastric pain or symptoms of heartburn. These symptoms are often related to the underlying cause of vomiting and not specifically to the Mallory-Weiss tear.
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Physical

  • No specific physical findings can be linked to the diagnosis of a Mallory-Weiss tear. Physical findings are linked to the underlying disorder causing the vomiting and retching.
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Causes

Many underlying disorders that cause vomiting and retching result in a Mallory-Weiss tear.

  • GI disease
    • Infectious gastroenteritis
    • Gastric outlet obstruction
    • Ulcers
    • Hiatal hernias
    • Malrotation
    • Volvulus
    • Inflammatory conditions of the stomach and intestine
  • Pregnancy: Some women develop hyperemesis gravidarum, a syndrome characterized by persistent severe vomiting and retching, in the first trimester of pregnancy. Gastric dysrhythmias and prolonged small-bowel motility cause the development of hyperemesis gravidarum. Some women lose as much as 10% of their body weight during this period.
  • Hepatitis: Acute inflammation of the liver causes vomiting in 10-20% of patients.
  • Cirrhosis
  • Biliary tract disease: Although rare in children, these conditions can cause vomiting typically associated with meals.
  • Renal disease: Vomiting is often associated with diseases affecting the kidneys, including the following:
  • Increased intracranial pressure: Intracranial lesions that cause hydrocephalus or increased intracranial pressure may lead to vomiting in children. Most common causes of hydrocephalus include tumors, cysts, and congenital abnormalities. Other causes of increased intracranial pressure consist of trauma, infections (eg, meningitis), medications, and pseudotumor cerebri.
  • Iatrogenic causes: Complications of endoscopy may cause esophageal tears (< 0.01% in children) and are almost always associated with a patient who is retching or struggling during the procedure. The use of polyethylene glycol lavage, when used for ingestions, severe constipation, or preparation for colonoscopy, may cause severe vomiting.
  • Other causes
    • Severe diabetic ketoacidosis
    • Toxins
    • Drugs (eg, chemotherapeutic agents)
  • Cyclic vomiting syndrome
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Contributor Information and Disclosures
Author

Carmen Cuffari, MD  Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Alan D Schmetzer, MD  Professor and Vice-Chair for Education, Director of Residency Training, Department of Psychiatry, Indiana University School of Medicine

Alan D Schmetzer, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, American Society of Transplant Surgeons, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

B UK Li, MD  Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Director, Pediatric Fellowships and Gastroenterology Fellowship, Medical Director, Functional Gastrointestinal Disorders and Cyclic Vomiting Program, Medical College of Wisconsin; Attending Gastroenterologist, Children's Hospital of Wisconsin

B UK Li, MD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Steven M Schwarz, MD, FAAP, FACN, AGAF  Professor of Pediatrics, Children's Hospital at Downstate, State University of New York Downstate Medical Center

Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research

Disclosure: Curemark, LLC Consulting fee Board membership; Centocor, Inc. Grant/research funds Independent contractor; Johnson & Johnson, Inc. Grant/research funds Independent contractor

Chief Editor

Carmen Cuffari, MD  Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Chris A Liacouras, MD, to the original writing and development of this article.

References

  1. Graham DY, Schwartz JT. The spectrum of the Mallory-Weiss tear. Medicine (Baltimore). Jul 1978;57(4):307-18. [Medline].

  2. [Guideline] Millward SF, Bakal CW, Weintraub JL, et al. Treatment of acute nonvariceal gastrointestinal tract bleeding. [online publication]. Reston (VA): American College of Radiology (ACR); 2006. [Full Text].

  3. Harris JM, DiPalma JA. Clinical significance of Mallory-Weiss tears. Am J Gastroenterol. Dec 1993;88(12):2056-8. [Medline].

  4. Yu PP, White D, Iannuccilli EA. The Mallory-Weiss syndrome in the pediatric population. Rare condition in children should be considered in the presence of hematemesis. R I Med J. Feb 1982;65(2):73-4. [Medline].

  5. Ament ME, Gans L, Christie DK. Experience with esophagogastro-duodenoscopy in diagnosis of 79 pediatric patients with hematemesis, melena or chronic abdominal pain. Gastroenterology. 1975;68:858-61.

  6. Countryman D, Norwood S, Andrassy RJ. Mallory-Weiss syndrome in children. South Med J. Nov 1982;75(11):1426-7. [Medline].

  7. Kim JW, Kim HS, Byun JW, et al. Predictive factors of recurrent bleeding in Mallory-Weiss syndrome. Korean J Gastroenterol. Dec 2005;46(6):447-54. [Medline].

  8. Higuchi N, Akahoshi K, Sumida Y, et al. Endoscopic band ligation therapy for upper gastrointestinal bleeding related to Mallory-Weiss syndrome. Surg Endosc. Sep 2006;20(9):1431-4. [Medline].

  9. Kerlin P, Bassett D, Grant AK. The Mallory-Weiss lesion: a five-year experience. Med J Aust. May 6 1978;1(9):471-3. [Medline].

  10. Lecleire S, Antonietti M, Iwanicki-Caron I, et al. Endoscopic band ligation could decrease recurrent bleeding in Mallory-Weiss syndrome as compared to haemostasis by hemoclips plus epinephrine. Aliment Pharmacol Ther. Aug 15 2009;30(4):399-405. [Medline].

  11. Kelly JA. Mallory-Weiss tear. In: Altschuler SM, Liacouras CA, eds. Clinical Pediatric Gastroenterology. Philadelphia, Pa: Chuchill-Livingstone; 1999:303-5.

 
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Mallory-Weiss tear. Typical longitudinal mucosal tear with overlying fibrinous exudate extending from the distal esophagus to the gastric cardia. Courtesy of C.J. Gostout, MD.
Mallory-Weiss tear. Retroflexed view of the cardia showing the typical location of the tear with a clean base.
 
 
 
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