Mallory-Weiss Syndrome Treatment & Management

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

Medical Care

Initial medical management is always supportive. Patients in whom conservative medical therapy is ineffective should have a consultation with a gastroenterologist for possible endoscopy.

  • Monitor vital signs closely, obtain a CBC count, and place a large-bore intravenous tube for fluid resuscitation.
  • Less than 5% of children require a blood transfusion.
  • Begin workup to determine the underlying cause of the retching and vomiting.
  • In most cases, Mallory-Weiss tears spontaneously resolve; however, consider pharmaceutical therapy in cases of persistent bleeding or complications (see Medication).
  • Esophageal balloon tamponade, although useful for patients with esophageal varices, should be considered only in extreme cases because the use of an esophageal balloon increases the risk of extending the esophageal tear.
  • Esophageal clips applied at the site of active bleeding.
  • Endoscopic band ligation has been used and was shown to be an effective and safe procedure for patients with severe bleeding.[9, 10]
  • Angiographic embolization of the vessels supplying blood flow to the esophageal tear has been reported in the adult literature but should be considered in children only under dire circumstances.
Next

Surgical Care

  • Only in extraordinary cases should surgical intervention be required. A consultation with a surgeon should be considered only in patients with persistent bleeding requiring transfusions and in whom the bleeding cannot be controlled by medication or by therapeutic upper endoscopy (see Medication).
Previous
Next

Consultations

  • An upper endoscopy (performed by a trained pediatric gastroenterologist) should be considered for all patients with persistent bleeding for whom medical therapy is unsuccessful.
Previous
Next

Diet

  • During the acute problem, keep patients on nothing by mouth (NPO).
  • Once resolved, provide the patient clear liquids and advance the diet as tolerated.
  • After complete resolution, no special diet is required. However, foods or liquids that may have been identified as contributing to the cause of the underlying problem (eg, excessive alcohol intake, food allergies) should be avoided.
Previous
Next

Activity

  • Once the esophageal bleeding has stopped, no activity restrictions are required.
Previous
Proceed to Medication
 
 
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.

 
Previous
Next
 
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.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.