Mallory-Weiss syndrome: clinical features and management

To report the clinical features, endoscopic appearance, management and outcome of patients with upper gastrointestinal bleeding due to Mallory-Weiss tear seen at our institution during the last seven years.

A retrospective study of all patients with upper gastrointestinal bleeding seen during the last seven years was performed. Patients who were bleeding from longitudinal non-perforating tear(s) of the gastro-oesophageal mucosa were included in the study and their clinical features, endoscopic appearance management and outcome were recorded.

During the study period 426 patients with upper gastrointestinal bleeding were seen. Sixty-six (15.5%) of these were found to have bled or were bleeding from Mallory-Weiss tear(s). Twenty-seven (41%) patients with Mallory-Weiss tear had no antecedent nausea, retching, abdominal pain or vomiting. Two patients had portal hypertension and a solitary case bled from an iatrogenic tear induced during routine upper gastrointestinal endoscopy. Multiple bleeding episodes were seen in 12% of cases. Twenty (30%) patients needed endoscopic sclerotherapy. Haemostasis was achieved in all. Except retrosternal pain, no procedure related complications were seen.

Mallory-Weiss tear is a common cause of upper gastrointestinal bleeding. Nearly half of the patients have no antecedent symptoms and presented for the first time with upper gastrointestinal bleeding. Endoscopic therapy is very effective and safe in producing haemostasis in these patients.