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[Mallory-Weiss syndrome. Clinical cases and review of the literature]
M Nincheri Kunz1, R Cozzani, O Valle
1I Divisione di Chirurgia Generale, Ospedale Civile, Andrea, La Spezia.
Abstract:
Once considered rare, Mallory-Weiss syndrome is today more frequently reported due to the introduction of endoscopy which reveals this syndrome in up to 15% of hemorrhages of the upper digestive tract. The etiopathogenesis is not limited to the three factors reported by Mallory and Weiss in 1929: vomit, alcohol and hematemesis. An important role is also played by ASA and the like. This syndrome is also frequently associated with hiatus hernia in which it appears to be a complication since the lesion seems to be caused by the difference between intragastric (above all in the pocket of the hiatus hernia) and intrathoracic transmural pressure. Every increase in the pressure gradient at this level appears to cause fissuration at the cardioesophageal junction. Even endoscopy using rigid instruments and unsufflation may provoke the onset. Anamnesis and an objective examination, common to other pathologies, are not of great value to diagnosis. Radiology also contributes little, unless an arteriography is performed within the context of a highly selective angiography. Endoscopy is the prime method of diagnosis and, in addition to revealing the site and extent of hemorrhage, may be used to achieve hemostasis. Preendoscopic hemostasis currently uses a wide range of methods ranging from sclerotherapy to the injection of drugs or chemical substances, such as ethanol, adrenalin and thrombin; monopolar and bipolar electrocoagulation, thermal probe, hemoclips and Nd:YAG laser are also used. According to the majority of authors, the course of the syndrome is benign unless there are complications such as mediastinitis, pneumonia ab ingestis or hepatic insufficiency. The degree of bleeding is also decisive and the number of blood units transfused is of particular importance in determining the prognosis. The authors report a 10-year survival rate of approximately 70%.
Insights
Mallory-Weiss syndrome, a tear in the esophagus, is increasingly diagnosed with endoscopy. Factors beyond vomit and alcohol, like hiatal hernia and NSAIDs, contribute to its development and treatment.
Area of Science:
- Gastroenterology
- Digestive Endoscopy
Background:
- Mallory-Weiss syndrome, once rare, is now frequently diagnosed due to advancements in endoscopy.
- Etiopathogenesis involves factors beyond traditional triggers like vomit and alcohol, including NSAIDs and hiatal hernia.
Observation:
- Hiatal hernia is a common association, with lesions potentially caused by pressure differences between intragastric and intrathoracic spaces.
- Increased pressure gradients at the cardioesophageal junction can lead to fissuration.
- Endoscopic procedures themselves, particularly with rigid instruments, can precipitate the condition.
Findings:
- Endoscopy is the primary diagnostic tool, identifying hemorrhage location and extent.
- Various endoscopic hemostasis techniques are available, including sclerotherapy, drug injection, electrocoagulation, and laser therapy.
- Prognosis is generally benign, but complications like mediastinitis and pneumonia can occur.
Implications:
- Accurate diagnosis and timely endoscopic intervention are crucial for managing Mallory-Weiss syndrome.
- Understanding contributing factors like hiatal hernia and NSAID use aids in prevention and management strategies.
- A 10-year survival rate of approximately 70% highlights the importance of effective treatment and managing complications.