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$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.