Mallory-Weiss tears occur due to violent projection of gastric contents against the lower esophagus (e.g. repetitive forceful vomiting), which results in mucosal and submucosal tear with involvement of the venous plexus. The resultant clinical syndrome is known as Mallory-Weiss syndrome.
This shouldn't be confused with Müller-Weiss syndrome, which refers to spontaneous multifactorial adult onset osteonecrosis of the navicular.
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Clinical presentation
Patients present with painless hematemesis.
Etiology
It is more common in people with alcohol use disorder or after episodes of binge drinking, after repeated episodes of retching or vomiting.
They can also happen as a result of an endoscopy 2.
Pathology
A Mallory-Weiss tear is a laceration that runs longitudinally in the distal esophagus or through the gastroesophageal junction.
Radiographic features
Radiographically, a mucosal laceration without transmural perforation is likely to be undetectable 2.
Fluoroscopy
On a barium swallow study, they may be undetectable 2.
On double-contrast barium swallow, these mucosal lacerations can be seen as thin, longitudinal collections of barium just above the gastroesophageal junction or distal esophagus 5.
CT
A mucosal laceration without transmural perforation is likely to be occult on CT. However, CT images of the esophagus many occasionally show evidence of hemorrhage or foci of extraluminal gas at a site of mucosal injury 2.
Treatment and prognosis
Unless there is persistent bleeding, the treatment like that of other mucosal lacerations, is supportive 2. Most patients with upper gastrointestinal hemorrhage from a Mallory-Weiss tear cease bleeding spontaneously and do not require specific therapy 3.
History and etymology
It was first described in 1929 by George Kenneth Mallory (1900-1986), American pathologist, and Soma Weiss (1898-1942), American physician 1.
Differential diagnosis
Boerhaave syndrome: no hematemesis as there is complete transmural disruption of the esophageal wall with blood escaping into the mediastinum or left pleural space
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