Mallory-Weiss Tear

A Mallory-Weiss tear (Mallory-Weiss syndrome) is a tear in the lining of your esophagus, usually where it meets your stomach. It most often happens after forceful or repeated vomiting, retching or coughing. It’s a common cause of bleeding in the upper digestive tract.

In many cases, the bleeding is mild and stops on its own. But sometimes, it can lead to serious blood loss. You may have signs like weakness and dizziness. You need urgent medical care for heavy bleeding.

Most Mallory-Weiss tears heal quickly, often on their own within a few days. Management depends on how much bleeding you have. Some people only need supportive care and medications, while others may need a procedure to stop the bleeding.

Symptoms of a Mallory-Weiss tear

The most common symptom is vomiting blood (hematemesis), which may look bright red or like coffee grounds. This often happens after episodes of vomiting or retching.

Other symptoms may include:

• Nausea or ongoing vomiting
• Black, tarry poop (melena)
• Abdominal (belly) pain
• Weakness or fatigue
• Dizziness or fainting (especially with major blood loss)

Some people have non-bloody vomiting or retching before the bleeding starts.

What does a Mallory Weiss tear look like?

A Mallory-Weiss tear usually looks like a thin, lengthwise crack in the lining (mucous membrane) of your esophagus. It runs up and down rather than across. You wouldn’t ever see this. But your provider may see it if they need to do a procedure to look inside your esophagus.

Most tears are between 0.75 and 1.5 inches long (2 to 4 centimeters), but they can vary in size. Some may extend slightly into the upper part of your stomach.

Mallory-Weiss tear causes

Mallory-Weiss tears typically happen when pressure in your belly suddenly increases. This pressure can cause a tear in the lining of your esophagus.

Common triggers include:

• Forceful or repeated vomiting or retching
• Severe coughing
• Straining or heavy lifting
• Seizures
• Blunt injury to your belly
• Medical procedures, like upper endoscopy or feeding tube placement

Risk factors

Several factors may increase your risk of developing a Mallory-Weiss tear, including:

• Heavy alcohol use
• Eating disorders
• Hyperemesis gravidarum
• Cyclic vomiting syndrome
• Hiatal hernia
• Gastroesophageal reflux disease (GERD)

But some people develop a Mallory-Weiss tear without any clear risk factors.

Complications of this condition

Most tears heal without problems, but possible complications include:

• Anemia
• Significant blood loss (hemorrhage)
• Low blood pressure
• Shock (in severe cases)
• Bleeding that comes back (rare)

How to diagnose a Mallory-Weiss tear

If you have signs of gastrointestinal bleeding, your healthcare provider may:

• Ask about your medical history, especially any recent vomiting, retching, coughing or straining
• Do a physical exam and check your vital signs, like your heart rate and blood pressure
• Check for signs of heavy bleeding or shock that need urgent care
• Order blood tests to look at your blood count and how well your blood clots

Your provider may suspect a Mallory-Weiss tear if you’re vomiting blood and recently had vomiting or retching.

To confirm the diagnosis, they’ll do an upper endoscopy. This test lets them look inside your esophagus and stomach to find the tear. It also helps rule out other causes of bleeding.

How is a Mallory-Weiss tear treated?

Treatment depends on how much bleeding you have. Many Mallory-Weiss tears stop bleeding on their own within 72 hours and only need supportive care, like:

• Fluids (through an IV if needed)
• Medicines to reduce stomach acid (proton pump inhibitors)
• Medicines to control nausea and vomiting

If bleeding continues or is severe, you may need treatment during an endoscopy. Providers can use different tools and techniques to stop the bleeding. These include:

• Injection therapy: Your provider injects epinephrine through the endoscope. Epinephrine stops the bleeding by closing the blood vessels around the tear.
• Electrocoagulation: Your provider seals the tear using an electrical current. They use a probe lowered through the endoscope to deliver the electrical current to the damaged tissue.
• Hemoclip: Your provider delivers a small metal clip through the endoscope. The clip pinches the tear closed.
• Band ligation: Your provider inserts a tube through the endoscope that 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.

In rare cases, if other treatments don’t work, you may need additional procedures or surgery.

How long does a Mallory-Weiss tear take to heal?

Most Mallory-Weiss tears heal within a few days. Recovery is usually quick, especially if bleeding stops on its own or you get treatment early.

When should I see my healthcare provider?

Get medical care right away if you:

• Are vomiting blood
• Have black, tarry poop
• Notice signs of serious blood loss, like dizziness, fainting or weakness

These symptoms may mean you have active bleeding in your gastrointestinal tract and need urgent care.

What can I expect if I have this condition?

The outlook for a Mallory-Weiss tear is usually very good. Most people recover fully, and the tear heals quickly without long-term problems.

It’s uncommon for bleeding to come back. If it does happen, it’s most likely within the first 24 hours. Serious complications are rare and more often related to other health conditions.