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Mallory-Weiss syndrome

Published by Bupa's health information team, May 2009.

This factsheet is for people who have Mallory-Weiss syndrome, or who would like information about it.

Mallory-Weiss syndrome is bleeding from a tear in your lower oesophagus. The tear is called a Mallory-Weiss tear.

The oesophagus
What is a Mallory-Weiss tear?
What is Mallory-Weiss syndrome?
Symptoms of Mallory-Weiss syndrome
Complications of Mallory-Weiss syndrome
Causes of Mallory-Weiss syndrome
Diagnosis of Mallory-Weiss syndrome
Treatment of Mallory-Weiss syndrome
Questions and answers
Related topics
Sources

The oesophagus

Your oesophagus is pipe that goes from your mouth to your stomach. It's also known as your gullet. It's made up of three layers. These layers are called the mucosa (or lining), the submucosa and the muscularis (the layer of muscle). The mucosa is the innermost layer.

What is a Mallory-Weiss tear?

A Mallory-Weiss tear is a tear in the mucosa layer of your oesophagus. Mallory-Weiss tears usually occur close to where your oesophagus meets your stomach.

What is Mallory-Weiss syndrome?

Mallory-Weiss syndrome is bleeding from a Mallory-Weiss tear. The amount of bleeding that comes from a tear can vary widely.

Mallory-Weiss syndrome can occur in both adults and children.

Symptoms of Mallory-Weiss syndrome

Symptoms of Mallory-Weiss syndrome include:

vomiting of blood (haematemesis)
blood in your faeces (melaena)
if blood loss is severe or carries on for a long period of time it can lead to dizziness and sometimes collapse

Complications of Mallory-Weiss syndrome

If there is a lot of bleeding from your Mallory-Weiss tear, it can lead to a condition called shock. This means that there isn't enough blood reaching your body tissues. Shock is a serious medical condition that requires emergency treatment.

Causes of Mallory-Weiss syndrome

Mallory-Weiss tears are most often caused by repeated vomiting, retching, or a vigorous bout of coughing.

Any condition that can cause you to repeatedly vomit, retch or cough can cause a Mallory-Weiss tear. Two of the more common causes of Mallory-Weiss syndrome are sickness after drinking too much alcohol and morning sickness during pregnancy. Less common causes include abdominal disorders that cause vomiting, such as gallstones, and bulimia.

Diagnosis of Mallory-Weiss syndrome

You may need to have an endoscopy to diagnose a Mallory-Weiss tear and exclude anything else that may have caused your symptoms, such as a stomach ulcer. Most people don't need to have an endoscopy as bleeding from a Mallory-Weiss tear usually stops on its own and the tear heals quickly once you have stopped vomiting or retching.

An endoscopy is a test that allows a doctor to look at the inside of your oesophagus. The test is done using a narrow, flexible, tube-like telescopic camera called an endoscope. The endoscope will be placed in your mouth and you will be asked to swallow it.

You won't be allowed to eat or drink anything for eight hours before you have an endoscopy. You may be given a sedative (calming drug) before the procedure to help you relax. If you aren't given a sedative, the back of your mouth will be sprayed with a throat spray. This will numb your throat so that you're able to swallow the endoscope more easily.

You will need to rest for a while after you have had an endoscopy. If the bleeding from the Mallory-Weiss tear has stopped you may be able to go home later the same day.

After your endoscopy you should only drink fluids to begin with. You should be able to eat normally again within 48 hours.

Treatment of Mallory-Weiss syndrome

The bleeding from a Mallory-Weiss tear usually stops on its own and the tear should heal quickly once you have stopped vomiting or retching. So, most people don't need any treatment.

You may need treatment if the bleeding doesn't stop on its own. You may also need treatment for the underlying cause of the vomiting, retching or coughing.

Medication

There are several types of drug your doctor may prescribe you to help your Mallory-Weiss tear to heal. These include the following.

Anti-emetic drugs. These are used to prevent nausea and vomiting, which may have caused your tear and can make it worse. An example of an anti-emetic drug is prochlorperazine.
Acid suppressants. These drugs stop your stomach producing acid and so allow the tear to heal more quickly. Examples of this type of drug are omeprazole and esomeprazole.
Drugs that protect the lining of your oesophagus and encourage the tear to heal. An example of this type of drug is sucralfate.

Non-surgical treatments

You may need to have endoscopic therapy if the bleeding from the tear doesn't stop on its own. This means that a doctor will use an endoscope to view the inside of your oesophagus and treat the tear. An endoscope is a narrow, flexible, tube-like telescopic camera.

Endoscopic therapy usually involves your doctor injecting a drug called epinephrine around the tear, through the endoscope. Epinephrine causes the blood vessels surrounding the tear to constrict, helping to stop the bleeding.

Another form of endoscopic therapy is heater probe endoscopic therapy. This form of therapy involves a doctor applying an electrical current to the area around the tear, guided by an endoscope. The electrical current will help to stop the bleeding.

Sometimes it's possible for a doctor to stop the bleeding by putting a small metal clip onto the blood vessels that are supplying the tear with blood. This is also done through an endoscope.

Angiographic embolisation is another way of controlling the bleeding if it's severe and hasn't responded to endoscopic therapy. If you have angiographic embolisation, a dye called contrast medium will be injected into your blood stream so that your blood vessels can be seen on an X-ray image. This will allow a doctor to find the blood vessels that are supplying blood to your Mallory-Weiss tear and close them off, stopping the bleeding.

Surgery

You're not likely to need surgery to repair your Mallory-Weiss tear. Surgery is only necessary if the bleeding is severe and can't be controlled with medication, endoscopic therapy or angiographic embolisation.