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Abstract:
A Mallory-Weiss tear is a mucosal laceration occurrring at or near the esophagogastric junction and is most often associated with vomiting. This is a common cause of upper gastrointestinal bleeding; in our series, 14% of patients presenting to the hospital because of upper gastrointestinal bleeding had Mallory-Weiss tears. Massive hemorrhage is not characteristic and 37% of the patients required no blood transufsions. A classical history of nonbloody emesis followed by hematemesis was found in only 29% of patients. The most common story was the appearance of blood with the first vomiting. In 35% of our patients with Mallory-Weiss tear, an additional potential bleeding site was identified, and, in approximately half of these patients, it was actually bleeding. Most Mallory-Weiss tears stop bleeding spontaneously and supportive treatment is all that is required. If bleeding continues, infusion of vasoactive substances into the celiac artery or into the left gastric artery often obviates the need for operation.
Insights
Mallory-Weiss tears, a common cause of upper GI bleeding, often present with vomiting. Most cases resolve spontaneously with supportive care, avoiding the need for surgery.
Area of Science:
- Gastroenterology
- Internal Medicine
Background:
- Mallory-Weiss tears are mucosal lacerations at the esophagogastric junction.
- They are a frequent cause of upper gastrointestinal bleeding.
Observation:
- 14% of upper GI bleeding cases in the series were Mallory-Weiss tears.
- A classic history was present in only 29% of patients.
- 35% of patients had an additional bleeding source.
Findings:
- Massive hemorrhage is uncommon; 37% required no transfusions.
- Most tears stop bleeding spontaneously.
- Vasoactive infusions can prevent surgery if bleeding persists.
Implications:
- Highlights the varied presentation of Mallory-Weiss tears.
- Emphasizes conservative management and interventional radiology options.
- Informs clinical suspicion for upper GI bleeding causes.