Mallory Weiss Syndrome

What is Mallory Weiss Syndrome?

Certain conditions which insist tearing of the lining of the esophagus cause significant hemorrhagic condition. The hemorrhage is prolonged due to delayed wound healing. The site of the injury occurs in the adjoining part of the stomach. ^{(1, 3, 5)}

Sign and symptoms

• Severe vomiting
• Abdominal pain
• Blood vomiting
• Unintentional strong attempt to vomit out (retching)
• Coughing
• Hiccups
• Clotted blood is excreted
• Dark colored or tarry stool (melenic) due to blood passage through anal route
• Excessive blood loss may lead to shock and
• Seizure
• Feeling of closed chest

The nature of bleeding during vomiting is heavy clotted blood is excreted out; the appearance of blood looks like coffee grounds. The blood excrete via stool looks like tar. In the rare instance fresh red colored blood can also appear.

The above mentioned symptoms are quite common with certain types of ailments. Even gastrointestinal bleeding occurs without abdominal pain. The expert can only decide the specificity of the appearance of the symptoms ; so it is advised immediate take medical consultation after first appearance of above the mentioned symptoms. In maximum instance, MALLORY WEISS SYNDROME is spontaneous in nature and related mortality occurs exceptionally. ^{(2, 4, 5)}

Diseases associated with Mallory Weiss Syndrome

• Zollinger-Ellison syndrome is a rare aliments, which increase acidic content of the stomach due to development of the small tumors. This is the prime cause of chronic ulcer development.
• Chronic inflammation of the stomach lining (erosive gastritis) leads ulcer-like lacerations
• Perforation or puncture of the esophagus
• A peptic ulcer
• Boerhaave’s syndrome or rip apart of the esophagus lining due to severe vomiting force (1,2, 4, 5)

Causes

Different medical condition can initiate Mallory Weiss Syndrome

One of the primary causes is severe vomiting. Sudden development of the severe abdominal pressure tear the esophageal lining at the adjoin part of the stomach. The different predisposing factors include hiatal hernia, severe traumatic injury to the abdomen or chest, extreme snoring, straining and lifting, tenderness of the lining of the esophagus (esophagitis) or stomach (gastritis), cardiopulmonary resuscitation (CPR), etc. Cancer chemotherapy can develop Mallory Weiss Syndrome, as a complication. (3, 4, 6)

Risk Factors

Regular heavy consumption of alcohol increases the risk factor for development of Mallory Weiss Syndrome by initiating the favorable pathogenesis. ^{(1, 6)}

Prevalence

The prevalence of MWS occurs at the age between 40 to 60 years; though children incidence rate is also clinically documented. The primary symptomatic approach is gastrointestinal bleeding episodes and that is accounts about 1 to 15% of suspected cases. Males are more susceptible to develop MALLORY WEISS SYNDROME than females. ⁽⁴⁾

Diagnosis

Initially the symptomatic discussion is the primary diagnosis approach. Doctor usually asks about the alcohol consumption habit. The recent onset of any disease is also another important question for estimating the underlying cause.

The esophagogastroduodenoscopy (EGD) test is a diagnostic process to get images of esophagus. The patient will get a sedative and pain killer injections before start the test. These medications help to reduce test related discomfort. Doctor inserts a flexible tube through the mouth, when patient’s feels sedation. The tube tip contains a camera. The camera takes internal images of esophageal lining, the valve present between esophagus and stomach. The doctor examines the images and identify the site of lesion present in esophagus or other associated area.

The doctor also recommended hematological tests including CBC (complete blood count) to estimate the hemoglobin content. Hemoglobin estimation helps to diagnose the severity of bleeding and its consequences. The Doctor identifies the Incidence of MWS depending upon these test results. ^{(4, 5, 6)}

Treatment

MWS can self limiting and the condition may rid of by their own way without incorporating any treatment. But the persistent bleeding need treatment to stop bleeding. The different treatment available are as follows:

Sealing of the lesion

There are two processes – cauterization (Chemical or heat application) or electrocoagulation (passage of high frequency electrical current) to seal the lesion and check the bleeding.

• Treatment for control the hemorrhagic condition
• vasopressive drugs contract the blood vessel and can assist to check the bleeding
• The application of hormone pitressin on muscles of the capillaries to control blood pressure.
• Balloon tamponade is also possible to check the bleeding. In this process, a balloon is inserted with the help of a catheter and later the balloon is inflated to impede the bleeding.
• Blood transfusion is required to replace normal blood content.
• Ulcer protecting medication like famotidine or lansoprazole may be prescribed to reduce acid production in the stomach and prevent ulcer. ^(4,5)

Pictures

Image 4 – Mallory-weiss syndrome vs Boerhaave’s syndrome

References

1. Carmen Cuffari, (2016); Mallory-Weiss Syndrome; Retrieve from: http://emedicine.medscape.com/article/931141-overview
2. Jenifer K. Lehrer (2014); Mallory-Weiss Syndrome; Retrieve from: https://www.nlm.nih.gov/medlineplus/ency/article/000269.htm
3. Mallory-Weiss Syndrome; Retrieve from: http://patient.info/in/doctor/mallory-weiss-syndrome-pro
4. Mallory Weiss Syndrome; National Organization For Rare Disorders; Retrieve from: http://rarediseases.org/rare-diseases/mallory-weiss-syndrome/
5. Darla Burke; Mallory-Weiss Syndrome; Retrieve from: http://www.healthline.com/health/mallory-weiss tear#Overview1
6. Moises Guelrud; Mallory-Weiss syndrome; Retrieve from: http://www.uptodate.com/contents/mallory-weiss-syndrome