Further Outpatient Care

Mallory-Weiss tears almost never rebleed; thus, follow-up is not usually indicated.

Further Inpatient Care

Two types of endoscopic therapy can be used to control severe bleeding in patients who are hemodynamically unstable because of bleeding from a Mallory-Weiss tear.

Injection therapy is favored as the first-line therapy by most endoscopists for control of bleeding esophageal lesions because of its ease of use, safety, and cost. Typically, the injections are made 3-5 mm apart circumferentially around the site of bleeding in 4 areas. The chemical agents used for injection therapy include dilute epinephrine, sodium morrhuate, ethyl alcohol, or sodium tetradecyl sulfate.
Heater probe or bipolar coagulation therapies use electrical current supplied by catheters that can be inserted into an endoscope to control bleeding. Approximately 20 joules (10-15 Watts) of current are used per individual pulse, and treatment is complete when the bleeding has ceased. The current is usually delivered in repeated time-limited pulses.

Evaluate the underlying cause of vomiting.

Transfer

Transfer children with severe uncontrolled bleeding to a tertiary care hospital with an in-house pediatric gastroenterologist.

Deterrence/Prevention

Avoid and treat causes of underlying vomiting and retching.

Complications

Complications include the following:

Anemia
Dehydration

Prognosis

Prognosis is extremely good in children, with a less than 0.01% mortality rate. These tears almost always respond to conservative therapy and supportive care.^[16]

Graham DY, Schwartz JT. The spectrum of the Mallory-Weiss tear. Medicine (Baltimore). 1978 Jul. 57(4):307-18. [QxMD MEDLINE Link].
[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].
Harris JM, DiPalma JA. Clinical significance of Mallory-Weiss tears. Am J Gastroenterol. 1993 Dec. 88(12):2056-8. [QxMD MEDLINE Link].
Ljubicic N, Budimir I, Pavic T, Bišcanin A, Puljiz Z, Bratanic A, et al. Mortality in high-risk patients with bleeding Mallory-Weiss syndrome is similar to that of peptic ulcer bleeding. Results of a prospective database study. Scand J Gastroenterol. 2014 Apr. 49(4):458-64. [QxMD MEDLINE Link].
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. 1982 Feb. 65(2):73-4. [QxMD MEDLINE Link].
Akhtar AJ, Padda MS. Natural history of Mallory-Weiss tear in African American and Hispanic patients. J Natl Med Assoc. 2011 May. 103(5):412-5. [QxMD MEDLINE Link].
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.
Countryman D, Norwood S, Andrassy RJ. Mallory-Weiss syndrome in children. South Med J. 1982 Nov. 75(11):1426-7. [QxMD MEDLINE Link].
Kerlin P, Bassett D, Grant AK. The Mallory-Weiss lesion: a five-year experience. Med J Aust. 1978 May 6. 1(9):471-3. [QxMD MEDLINE Link].
Kim JW, Kim HS, Byun JW, et al. Predictive factors of recurrent bleeding in Mallory-Weiss syndrome. Korean J Gastroenterol. 2005 Dec. 46(6):447-54. [QxMD MEDLINE Link].
Fujisawa N, Inamori M, Sekino Y, Akimoto K, Iida H, Takahata A, et al. Risk factors for mortality in patients with Mallory-Weiss syndrome. Hepatogastroenterology. Apr/2011. 58:417-20. [QxMD MEDLINE Link].
Ivekovic H, Radulovic B, Jankovic S, Markos P, Rustemovic N. Combined use of clips and nylon snare ("tulip-bundle") as a rescue endoscopic bleeding control in a mallory-weiss syndrome. Case Rep Gastrointest Med. 2014. 2014:972765. [QxMD MEDLINE Link]. [Full Text].
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. 2009 Aug 15. 30(4):399-405. [QxMD MEDLINE Link].
Cho YS, Chae HS, Kim HK, et al. Endoscopic band ligation and endoscopic hemoclip placement for patients with Mallory-Weiss syndrome and active bleeding. World J Gastroenterol. 2008 Apr 7. 14(13):2080-4. [QxMD MEDLINE Link]. [Full Text].
Park CH, Min SW, Sohn YH, et al. A prospective, randomized trial of endoscopic band ligation vs. epinephrine injection for actively bleeding Mallory-Weiss syndrome. Gastrointest Endosc. 2004 Jul. 60(1):22-7. [QxMD MEDLINE Link].
Kelly JA. Mallory-Weiss tear. Altschuler SM, Liacouras CA, eds. Clinical Pediatric Gastroenterology. Philadelphia, Pa: Chuchill-Livingstone; 1999. 303-5.
Higuchi N, Akahoshi K, Sumida Y, et al. Endoscopic band ligation therapy for upper gastrointestinal bleeding related to Mallory-Weiss syndrome. Surg Endosc. 2006 Sep. 20(9):1431-4. [QxMD MEDLINE Link].
Shimoda R, Iwakiri R, Sakata H, et al. Endoscopic hemostasis with metallic hemoclips for iatrogenic Mallory-Weiss tear caused by endoscopic examination. Dig Endosc. 2009 Jan. 21(1):20-3. [QxMD MEDLINE Link].

Media Gallery

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.

of 2

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, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Prometheus Laboratories for speaking and teaching; Received honoraria from Abbott Nutritionals for speaking and teaching. for: Abbott Nutritional, Abbvie, speakers' bureau.

Specialty Editor Board

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, Medical College of Wisconsin; Attending Gastroenterologist, Director, Cyclic Vomiting Program, Children’s Hospital of Wisconsin

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

Disclosure: Nothing to disclose.

Chief Editor

Additional Contributors

Eric S Maller, MD

Eric S Maller, 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, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

Acknowledgements

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