Mallory-Weiss syndrome

Published by Bupa’s Health Information Team, May 2011.

This factsheet is for people who have Mallory-Weiss syndrome, or who would like information about it.

Mallory-Weiss syndrome is a condition in which the main symptom is bleeding from a tear in the lower oesophagus – the pipe that goes from the mouth to the stomach. The tear is called a Mallory-Weiss tear.

About Mallory-Weiss syndrome

A Mallory-Weiss tear is a tear in the lining of your oesophagus. Your oesophagus is made up of three layers – the mucosa (the lining), the submucosa and the muscularis (the deeper muscle). The mucosa is the innermost layer (the lining of your oesophagus).

Mallory-Weiss tears usually occur close to where your oesophagus meets your stomach. Mallory-Weiss syndrome refers to symptoms such as bleeding that you can get from these tears. The amount of bleeding that comes from a Mallory-Weiss tear can vary widely.

Mallory-Weiss syndrome can occur in both adults and children.

Symptoms of Mallory-Weiss syndrome

Symptoms of Mallory-Weiss syndrome can include:

• vomiting of blood – this is the most common symptom
• blood in your faeces – your faeces may be very dark in colour
• light-headedness and fainting if you have lost a lot of blood
• abdominal pain (pain in your tummy)

These symptoms aren't always caused by Mallory-Weiss syndrome but if you have them, see your GP.

Complications of Mallory-Weiss syndrome

If there is a lot of bleeding from your Mallory-Weiss tear, it can lead to a condition called hypovolaemic shock. This means that there isn't enough blood reaching your body tissues. Hypovolaemic shock is a serious medical condition that can damage your vital organs such as your brain, heart and kidneys. Symptoms of hypovolaemic shock can include feeling cold, light-headed and confused. If you develop these symptoms or your bleeding is severe, call for emergency help.

Causes of Mallory-Weiss syndrome

A Mallory-Weiss tear is usually caused by forceful or repeated vomiting, retching or coughing. Any condition that can cause you to repeatedly vomit, retch or, less commonly, cough can cause a Mallory-Weiss tear and Mallory-Weiss syndrome. Two of the more common causes of Mallory-Weiss syndrome are sickness after drinking too much alcohol and morning sickness during pregnancy. People who have an eating disorder called bulimia are also more likely to have Mallory-Weiss syndrome.

Diagnosis of Mallory-Weiss syndrome

If you visit your GP with symptoms of a Mallory-Weiss tear, he or she will examine you and check for signs of what could be causing your symptoms. He or she may take your blood pressure and pulse. Your GP will also ask you about your medical history.

You will usually need to be admitted to hospital for treatment or observation. At the hospital, you may have an endoscopy (also known as a gastroscopy) done by a gastroenterologist (a doctor who specialises in identifying and treating conditions that affect the digestive system). This can diagnose a Mallory-Weiss tear and rule out other conditions that may be causing your symptoms. The procedure allows your doctor to look inside your oesophagus using a narrow, flexible, telescopic camera called an endoscope (or gastroscope). You will need to swallow the endoscope and it is then passed down your oesophagus. This procedure can also sometimes be used to treat a Mallory-Weiss tear.

Treatment of Mallory-Weiss syndrome

The bleeding from a Mallory-Weiss tear usually stops on its own and the tear heals within 48 hours of you stopping vomiting, retching or coughing. So, most people don't need any specific treatment. However, you will need to stay under observation until the bleeding has stopped.

You will need treatment if the bleeding doesn't stop on its own. You may also need investigation or treatment for the underlying cause of the vomiting, retching or coughing.

Medicines

There are several types of medicines your doctor may prescribe to help your Mallory-Weiss tear to heal. These include the following.

• Anti-emetic medicines (eg prochlorperazine). These are used to stop you feeling sick and vomiting, if this caused your tear or is making it worse.
• Acid suppressants (eg omeprazole and lansoprazole). These medicines stop your stomach producing acid and so allow the tear to heal more quickly.
• Medicines to protect the lining of your oesophagus and encourage the tear to heal (eg sucralfate).

Non-surgical treatments

Your doctor may recommend a type of treatment that uses an endoscope (known as endoscopic therapies). These include the following.

• Injecting a medicine called adrenaline around the tear. Adrenaline causes the blood vessels to close and tighten around the tear, helping to stop the bleeding.
• Heat therapy (multipolar electrocoagulation or heater probe). An electrical current is applied to the area around the tear to seal the blood vessels.
• Metal clipping (endoscopic haemoclipping). The blood vessel supplying the tear with blood is closed with a metal clip.

If your bleeding is severe and hasn't responded to endoscopic therapy, your doctor may suggest another type of procedure, called angiography with embolisation. If you have an angiography, a radiologist (a doctor who specialises in using imaging methods to diagnose medical conditions) or other specialist doctor will inject a special dye (contrast agent) into your bloodstream so that the blood vessels supplying the Mallory-Weiss tear can be seen on an X-ray. Your doctor will then be able to stop the bleeding by injecting a compound directly into the blood vessel to close it off (embolisation).

Surgery

Surgery is rarely used to treat a Mallory-Weiss tear. Surgery is only necessary if the bleeding is severe and can't be controlled with medicines, endoscopic therapy or angiography with embolisation. 

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.