BANGALORE: A Mallory-Weiss tear occurs in the mucous membrane of the oesophagus, where it connects to the stomach. The tear may bleed. It’s alternative name is mucosal lacerations - gastroesophageal junction. The condition was first described in 1929 by G Kenneth Mallory and Soma Weiss in 15 alcoholic patients.
Known causes Mallory-Weiss tears do not happen very often. They are usually caused by forceful or long-term vomiting or coughing.
They may also be caused by epileptic convulsions. The tear may be followed by vomiting bright red blood or by passing blood in the stool. Any condition that leads to violent and lengthy bouts of coughing or vomiting can cause these tears. Conditions that cause excessive vomiting are alcoholism, pregnancy, bulimia (patient forces himself to vomit after each meal).
Identify it Some of the symptoms include bloody stools and vomiting blood (bright red).
Repeated bleeding is uncommon unless there is also a problem with blood clotting.
The outcome is expected to be good. A complication that may occur is haemorrhage (loss of blood).
The signs and tests for the Mallory- Weiss tear syndrome are CBC possibly showing low hematocrit and EGD (esophagogastroduodenoscopy) showing a tear with bleeding.
Prevention Treatments to relieve vomiting and coughing may reduce risk. Avoid excessive alcohol use.
Treatment The tear usually heals in about 10 days without treatment. Surgery is rarely required. Drugs that suppress stomach acid (proton pump inhibitors or H2 blockers) may be given, but it is not clear if they are helpful.
If blood loss has been great, blood transfusions may be necessary. Excessive bleeding may need to be treated by using an endoscope (see EGD). In most cases, bleeding stops without treatment within a few hours.
The majority of bleedings stop with conservative therapy in the hospital. Putting the patient on intravenous fluids until the bleeding stops is afvisable. Usually, a liquid diet is given after bleeding stops, gradually advancing to solids.
Avoiding alcohol and certain other drugs that cause more bleeding is advisable.
Medications to decrease vomiting are often prescribed.
The bleeding can also be stopped during endoscopy using electro-coagulation (that is, heating and burning the tear until it forms a scar), or by injecting medications such as epinephrine. About 5 per cent of cases require surgery for uncontrolled bleeding. Surgery is also indicated when conservative therapy fails.