Mallory Weiss Tear

What are Mallory Weiss tears?

Your esophagus is a tube that connects your throat to your stomach. In Mallory Weiss syndrome, the inner lining of your esophagus splits open and bleeds. These splits, called Mallory Weiss tears, occur at or near where your esophagus meets your stomach.

Mallory Weiss tears are named after two physicians named Kenneth Mallory and Soma Weiss. In 1929, they described tears in the lower esophagus in people who experienced forceful retching or vomiting after drinking too much alcohol.

In most cases, Mallory Weiss tears heal on their own, though some people require treatment.

What does a Mallory Weiss tear look like?

A Mallory Weiss tear usually looks like a crack that runs up and down your esophagus, like a split hose. On average, tears are between 0.75 and 1.5 inches long, or the width of one to two nickels. Some tears may extend into your upper stomach.

Who is at risk for Mallory Weiss tears?

Mallory Weiss tears most commonly affect people between ages 40 and 60. Men are two to four times more likely than women to develop a Mallory Weiss tear. Children rarely develop a Mallory Weiss tear.

How common are Mallory Weiss tears?

Healthcare providers find between 1% and 15% of people with bleeding of their esophagus or stomach have Mallory Weiss tears.

What causes Mallory Weiss tears?

Mallory Weiss tears are caused by increased pressure in the abdomen. Scientists think that the abdominal pressure forces the contents of the stomach into the esophagus, leading to tears.

Causes of increased abdominal pressure include:

• Severe vomiting or retching.
• Heavy lifting or straining.
• Prolonged coughing.
• CPR.
• Trauma to the abdomen or chest.

Some conditions increase your risk of getting a Mallory Weiss tear:

• Heavy alcohol use, which is involved in about 50% to 70% of people with Mallory Weiss tears.
• Bulimia, an eating disorder characterized by bingeing and vomiting.
• Cyclic vomiting syndrome (CVS), a condition of repeated attacks of nausea, vomiting and exhaustion.
• Esophageal varices, enlarged veins in the esophagus.
• Hyperemesis gravidarum, severe nausea and vomiting during pregnancy.
• Gastroesophageal reflux disease (GERD), when stomach acid backs up into your esophagus and mouth.
• Portal hypertension, high blood pressure in the vein that carries blood from your digestive organs to your liver.

An upper endoscopy or transesophageal echocardiogram rarely causes a Mallory Weiss tear.

What are the symptoms of Mallory Weiss tears?

The most common symptom of a Mallory Weiss tear is vomiting blood, which occurs in about 85% of cases. The blood can appear bright red or dark brown, like coffee grounds.

Other symptoms associated with Mallory Weiss tears include:

• Dark, sticky stools.
• Dizziness.
• Fainting.

What are the complications of Mallory Weiss tears?

Left untreated, blood loss from a Mallory Weiss tear can cause anemia, fatigue and shortness of breath.

If the tear is severe and internal bleeding occurs, you may experience symptoms of shock such as:

• Anxiety or agitation.
• Dry mouth or thirst.
• Nausea.
• Pale, cold and clammy skin.
• Rapid heartbeat or heart palpitations.
• Shallow, rapid breathing.
• Weakness.

How are Mallory Weiss tears diagnosed?

If you're experiencing signs of gastrointestinal bleeding, your healthcare provider will:

• Ask you about your medical history, especially conditions that cause vomiting, retching, straining or coughing.
• Perform a physical exam to check your vital signs.
• Assess you for severe bleeding or shock that might require emergency treatment.
• Draw blood for lab testing, such as a complete blood count (CBC), coagulation profile or kidney function test.

What tests are used to diagnose Mallory Weiss tears?

Healthcare providers typically use upper endoscopy to diagnose Mallory Weiss tears and rule out other disorders of your esophagus.

During the endoscopy, your provider guides a long, thin, flexible probe (endoscope) down your throat. Using a camera on the end of the probe, your provider looks for tears in your esophagus and upper stomach.

How are Mallory Weis tears treated?

In most patients with Mallory Weiss tears, the bleeding stops on its own within 72 hours.

To help your esophagus and stomach heal, your healthcare provider will likely prescribe medication to reduce stomach acid. The main types of acid reducers are:

• H2-receptor blockers.
• Proton pump inhibitors.

Your provider will continue to track your symptoms to ensure you are healing.

Do I need surgery to treat a Mallory Weiss tear?

If a Mallory Weiss tear continues to bleed or stops bleeding then starts again, endoscopic treatments can help. These treatments are less invasive than surgery.

The most common endoscopic treatments for Mallory Weiss tears are:

• Endoscopic injection therapy: Your provider injects epinephrine through the endoscope. Epinephrine stops the bleeding by closing the blood vessels around the tear. Because epinephrine can affect the heart, you should avoid this type of therapy if you have a history of coronary artery disease.
• Endoscopic electrocoagulation: Electrocoagulation includes several techniques to seal the tear using an electrical current. The provider uses a probe lowered through the endoscope to deliver the electrical current to the damaged tissue.
• Endoscopic hemoclip: A hemoclip is a small metal clip the provider delivers through the endoscope that pinches the tear closed.
• Endoscopic band ligation: Your provider inserts a tube through the endoscope and covers the tear with the end of the tube. The tube sucks in the tissue and wraps a band around it, like tying off the end of a small balloon. The band cuts off blood flow to the area and stops the bleeding.

If endoscopic treatments are unsuccessful, your provider may consider angiotherapy. This procedure targets the blood vessels that feed blood to the torn area. Your provider will:

1. Use a catheter to reach the artery.
2. Through the catheter, inject a drug such as vasopressin to close off the artery or use gel to plug it.

Surgery is the last option if both endoscopic treatment and angiotherapy do not stop the bleeding. Your provider will use a minimally invasive laparoscopic procedure to sew the tear closed.

How can I prevent Mallory Weiss tears?

You can prevent Mallory Weiss tears by avoiding persistent, forceful vomiting and excessive alcohol use, the most common causes of Mallory Weiss tears. By reducing your alcohol consumption, you can decrease your risk. If you need help, talk to your healthcare provider. They can connect you with resources to help you lower your alcohol use.

What conditions put me at higher risk for Mallory Weiss tears?

Alcohol use is the most common risk factor for Mallory Weiss tears.

Other conditions can also raise your risk. If you are pregnant with hyperemesis gravidarum or have conditions such as GERD, bulimia or CVS, talk to your provider. Preventive care can reduce your risk of these tears.

Can Mallory Weiss tears be cured?

Mallory Weiss tears usually heal on their own and rarely reoccur.

What can I expect after treatment for a Mallory Weiss tear?

If you needed endoscopic or surgical treatment for a Mallory Weiss tear, your medical team will monitor your recovery closely.

When should I go to the ER?

You should go to the ER if you have signs of bleeding in your gastrointestinal tract, such as blood in your vomit or dark, sticky stools.

A note from Cleveland Clinic

Mallory Weiss tears are one of many causes of bleeding in the upper gastrointestinal tract. The main symptoms (bloody vomit and dark, sticky stools) require an urgent medical evaluation to assess their severity. Though your healthcare provider will monitor you closely, most Mallory Weiss tears heal on their own. If bleeding continues, effective, noninvasive treatments are available. You can lessen your risk of a Mallory Weiss tear by reducing or eliminating your alcohol use. If you need help, reach out to your provider. They can connect you with resources to help you adopt a healthier lifestyle.