In 1929, Kenneth Mallory and Soma Weiss first described a syndrome characterized by esophageal bleeding caused by a mucosal tear in the esophagus as a result of forceful vomiting or retching. The initial description was associated with alcoholic binging; however, with the advent of endoscopy, Mallory-Weiss tears have been diagnosed in many patients with no antecedent history of alcohol intake. The tear typically occurs after repeated episodes of vomiting or retching, but it may occur after a single incident. [1] Although most written reports of these tears relate to adults, Mallory-Weiss tears also occur in children.
Any disorder that initiates vomiting may result in the development of a Mallory-Weiss tear, which develops as a linear laceration at the gastroesophageal junction because the esophagus and stomach are cylindrical. The cylindrical shape allows longitudinal tears to occur more easily than circumferential tears. These tears have been postulated to occur either by a rapid increase in intragastric pressure and distention, which increases the forceful fluid ejection through the esophagus, or secondary to a significant change in transgastric pressure (ie, difference in pressure across the gastric wall) because negative intrathoracic pressure and positive intragastric pressure leads to distortion of the gastric cardia, resulting in a gastric or esophageal tear. Aside from those patients who present with upper GI bleeding secondary to an alcohol binge, Mallory-Weiss tears occur more commonly in people with hiatal hernias.
Initial medical management is always supportive. Patients in whom conservative medical therapy is ineffective should have a consultation with a gastroenterologist for possible endoscopy.
Closely monitor vital signs, obtain a CBC count, and place a large-bore intravenous tube for fluid resuscitation.
Less than 5% of children require a blood transfusion.
Begin workup to determine the underlying cause of the retching and vomiting.
In most cases, Mallory-Weiss tears spontaneously resolve; however, consider pharmaceutical therapy in cases of persistent bleeding or complications (Vasopressin administered systemically may control cases of severe bleeding in patients with Mallory-Weiss syndrome.).
Esophageal balloon tamponade, although useful for patients with esophageal varices, should be considered only in extreme cases because the use of an esophageal balloon increases the risk of extending the esophageal tear.
Esophageal clips should be applied at the site of active bleeding.
Endoscopic band ligation has been used and was shown to be an effective and safe procedure for patients with severe bleeding.
(Medscape)