$Unique_ID{BRK03963} $Pretitle{} $Title{Mallory-Weiss Syndrome} $Subject{Mallory-Weiss Syndrome Mallory-Weiss Laceration Mallory-Weiss Tear Gastroesophageal Laceration-Hemorrhage Syndrome Boerhaave Syndrome Esophagus Perforation Gastritis Chronic Erosive Zollinger-Ellison Syndrome Hiccups Peptic Ulcer Esophageal Varices } $Volume{} $Log{} Copyright (C) 1989 National Organization for Rare Disorders, Inc. 734: Mallory-Weiss Syndrome ** IMPORTANT ** It is possible that the main title of the article (Mallory-Weiss Syndrome) is not the name you expected. Please check the SYNONYM listing to find the alternate names and disorder subdivisions covered by this article. Synonyms Mallory-Weiss Laceration Mallory-Weiss Tear Gastroesophageal Laceration-Hemorrhage Syndrome Information on the following diseases can be found in the Related Disorders section of this report: Boerhaave Syndrome Esophagus Perforation Gastritis, Chronic Erosive Zollinger-Ellison Syndrome Hiccups Peptic Ulcer Esophageal Varices General Discussion ** REMINDER ** The information contained in the Rare Disease Database is provided for educational purposes only. It should not be used for diagnostic or treatment purposes. If you wish to obtain more information about this disorder, please contact your personal physician and/or the agencies listed in the "Resources" section of this report. Mallory-Weiss Syndrome is a laceration of the mucous membrane in the junction between the esophagus and the stomach (gastroesophageal). It is usually caused by severe vomiting and can lead to hemorrhaging. Symptoms Mallory-Weiss Syndrome is characterized by a tear in the mucous membrane of the junction between the stomach and esophagus. It is most commonly characterized by abdominal pain, a history of severe vomiting, and vomiting blood (hematemesis). The blood is often clotted and has the appearance of "coffee grounds". The stools will be black and tarry (melena). In cases where there is a substantial loss of blood there may be shock and collapse. A diagnosis of this disorder can be made by visual examination of the esophagus membrane through an endoscope. Causes In Mallory-Weiss Syndrome the tear between the stomach and esophagus is usually caused by severe vomiting. It can also result from a severe trauma to the chest or abdomen, chronic hiccups, intense snoring, lifting and straining, alcoholism, an inflammation of the lining of the stomach (gastritis) or esophagus (esophagitis), hiatus hernia, convulsions or CPR (cardiopulmonary resuscitation). Cancer patients undergoing chemotherapy may get this disorder as a complication of chemotherapy. Affected Population Mallory-Weiss Syndrome accounts for about 10% of all gastrointestinal bleeding episodes. It is more common in alcoholics and affects males and females in equal numbers. Related Disorders Symptoms of the following disorders can be similar to those of Mallory-Weiss Syndrome. Comparisons may be useful for a differential diagnosis: Zollinger-Ellison Syndrome is a rare disorder characterized by small tumors (usually in the pancreas) which secrete a hormone that produces excess amounts of stomach acids that cause ulcers. These tumors can also appear in the lower stomach wall, spleen or lymph nodes close to the stomach. Large amounts of gastric acid can be found in lower stomach areas where many ulcers form. Ulcers can appear suddenly even in areas where they are rarely found, may persist following treatment, and can be accompanied by diarrhea. Prompt medical treatment of these ulcers is necessary to prevent complications such as bleeding and perforation. (For more information on this disorder, choose "Zollinger" as your search term in the Rare Disease Database.) Chronic Erosive Gastritis is a common inflammation of the stomach characterized by multiple lesions in the mucous lining, causing ulcer-like symptoms. These symptoms may include a burning and heavy feeling in the pit of the stomach, mild nausea, vomiting, loss of appetite and weakness. In severe cases there can be bleeding of the stomach which may result in anemia. Some people with this disorder, especially chronic aspirin users, may show no apparent symptoms until the disease has advanced. An accurate diagnosis can be made by a physician's visual inspection of the stomach using a gastroscope. (For more information on this disorder, choose "Gastritis, Chronic Erosive" as your search term in the Rare Disease Database.) Boerhaave's Syndrome is a very serious disorder that is characterized by a rupture of the esophagus. It usually occurs from severe vomiting after excessive eating. Those with this disorder may have severe stomach and chest pain, shortness of breath (dyspnea), rapid heartbeat (tachycardia), a blue discoloration of the skin (cyanosis) and eventually circulatory failure due to the loss of blood (shock) through the esophagus. Surgery is usually required to repair this type of rupture. It is important that this disorder be diagnosed promptly so that medical treatment may be administered as soon as possible. Esophagus Perforation is a rupture of the esophagus. When the rupture occurs in the throat area there may be swelling of the neck and continuous pain that extends from the chest to the back. If it occurs in the chest, there may be vomiting, upper abdominal pain, shortness of breath (dyspnea), and severe chest pain. This disorder can be caused by chemical burns in the throat, complications due to an inflammation of the esophagus (esophagitis), peptic ulcer, or an abnormal growth (neoplasm). Diagnostic medical procedures such as endoscopy or gastroscopy can also cause perforation of the esophagus. Peptic Ulcer is a very common disorder characterized by lesions of the mucous membranes of the esophagus, stomach or duodenum. These lesions are caused by an over-secretion of acid or pepsin and are characterized by pain, heartburn, nausea and vomiting. Esophageal Varices are dilated, enlarged, and tortuous veins, arteries or lymphatic vessels at the lower end of the esophagus as a result of portal hypertension; they are superficial and liable to ulceration and massive bleeding. The following disorder may be associated with Mallory-Weiss Syndrome. It is not necessary for a differential diagnosis: Chronic hiccups are sudden, involuntary repeated spasms of the diaphragm. They can last for hours or days, or they recur very often with only a few hours relief between spasms. The persistence of hiccups may indicate a serious illness. Some of the illnesses that include persistent hiccups as a symptom are: pleurisy of the diaphragm, pneumonia, uremia, alcoholism, disorders of the stomach or esophagus, and bowel diseases. Hiccups may also be associated with pancreatitis, pregnancy, bladder irritation, liver cancer, hepatitis, surgery, tumors, lesions and gastroesophageal tears. (For more information on this disorder, choose "Hiccups" as your search term in the Rare Disease Database.) Therapies: Standard In many cases, bleeding caused by Mallory-Weiss Syndrome will stop without treatment. In cases where the bleeding persists, treatment may include sealing the lesion by applying heat or chemicals (cauterization) or high frequency electrical current (electrocoagulation). Blood transfusions and/or the vasopressive drug, pitressin, may be required. Direct pressure may also be used by inserting a catheter which is surrounded by a balloon. The balloon is then inflated (balloon tamponade) to stop the bleeding. Surgery is usually not necessary unless the bleeding cannot be controlled by conservative measures. Other treatment is symptomatic and supportive. Therapies: Investigational Researchers are studying the effectiveness of embolization as a treatment for massive uncontrolled bleeding of the esophagus. This procedure consists of inserting a substance, such as gelfoam, bucrylate, or alcohol (ethanol) and stainless steel coils into the affected area. Further studies will be necessary to determine long-term safety and effectiveness of this treatment. The orphan drug sodium tetradecyl sulfate (Sotradecol) is being used as an experimental treatment for bleeding esophageal varices. For more information on the Orphan Drug sodium tetradecyl sulfate, physicians can contact Elkins-Sinn, Inc., 2 Esterbrook Lane, Cherry Hill, NJ 08003-4099. This disease entry is based upon medical information available through January 1990. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. Resources For more information on Mallory-Weiss Syndrome, please contact: National Organization for Rare Disorders (NORD) P.O. Box 8923 New Fairfield, CT 06812-1783 (203) 746-6518 National Digestive Diseases Information Clearinghouse Box NDIC Bethesda, MD 20892 (301) 468-2162 References INTERNAL MEDICINE, 2nd Ed.: Jay H. Stein, ed.-in-chief; Little, Brown and Co., 1987. Pp. 82. THE MERCK MANUAL, 15th Ed.: Robert Berkow, M.D., ed.-in-chief; Merck, Sharp & Dohme Laboratories., 1987. Pp. 724. UPPER GASTROINTESTINAL BLEEDING. J. Lancaster; PRIM CARE, (March 1988, issue 15 (1)). Pp. 31-41. MULTIPOLAR ELECTROCOAGULATION IN THE TREATMENT OF ACTIVE UPPER GASTROINTESTINAL TRACT HEMORRHAGE. A PROSPECTIVE CONTROLLED TRIAL. L. Laine; N ENGL J MED, (June 25, 1987, issue 316 (26)). Pp. 1613-1617. MALLORY-WEISS TEAR. A COMPLICATION OF CANCER CHEMOTHERAPY. M. Fishman, et al.; CANCER, (December 1, 1983, issue 52 (11)). Pp. 2031-2032. SNORE-INDUCED MALLORY-WEISS SYNDROME. J. Merrill; J CLIN GASTROENTEROL, (February 1987, issue 9 (1)). Pp. 88-89. MALLORY-WEISS SYNDROME. A STUDY OF 224 PATIENTS. C. Sugawa, et al.; AM J SURG, (January 1983, issue 145 (1)). Pp. 30-33. PERCUTANEOUS TRANSHEPATIC EMBOLIZATION OF GASTROPHAGEAL VARICES: RESULTS IN 400 PATIENTS. C.L. Hermine, et al.; (April 1989, issue 152 (4)). Pp. 775-760.