Mallory-Weiss Syndrome Workup

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

Laboratory Studies

  • No specific laboratory tests are indicated for determining the etiology of a Mallory-Weiss tear.
  • Obtain a CBC count to determine the severity of bleeding.
  • Coagulation parameters should be assessed.
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Imaging Studies

  • No specific imaging studies exist that can positively identify an esophageal tear.
  • Several retrospective studies have demonstrated that barium esophagraphy may reveal small esophageal hematomas or thick streaks where the barium becomes trapped in the tear. However, only 20% of patients with a Mallory-Weiss tear had positive radiologic findings, and, in all cases, an upper endoscopy was performed for definitive diagnosis.
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Procedures

  • Esophagogastroduodenoscopy[6]
    • Upper endoscopy is the diagnostic tool for esophageal tears.[7]
    • Visual inspection of the esophagus, stomach, and duodenum is essential in the evaluation of a child presenting with hematemesis.
    • The hallmark of a Mallory-Weiss tear is the visual appearance of one or more linear bleeding lesions at or just proximal to the esophagogastric junction.
    • Perform endoscopy within 24 hours of the bleeding episode.
    • Tears visualized within 24 hours usually have a soft, fresh, mounded, brownish-red appearance on the surface of the mucosa.
    • After 48-72 hours, the tear looks like a mucosal cleft that may be surrounded by erythematous mucosa.
    • By 96 hours, most Mallory-Weiss lesions are well healed and may be difficult to visualize.
    • In cases of severe bleeding with hemodynamic instability, the patient should be stabilized prior to performing endoscopy.
    • Mallory-Weiss tears can heal quickly after the cessation of vomiting and retching and may not be diagnosed if performance of the upper endoscopy is delayed.
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Staging

Predictive factors for recurrent bleeding include the following:[8]

  • Initial presentation of shock
  • Liver cirrhosis
  • Decreased hemoglobin and platelet count
  • Need for blood transfusion
  • Intensive care management
  • Active bleeding noted at the time of endoscopy
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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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