[Science Popularization] Mallory-Weiss Syndrome

[Science Popularization] Mallory-Weiss Syndrome

Mallory-Weiss syndrome refers to longitudinal laceration of the mucosa at the junction of the lower esophagus and the stomach. It causes upper gastrointestinal bleeding, which is often self-limiting. However, if a small artery is involved, it can lead to severe bleeding. The primary cause is a sudden increase in intra-abdominal or intra-gastric pressure, which prompts the mucosal tear. The main factors leading to a rise in gastric pressure include severe vomiting due to conditions like hyperemesis gravidarum, esophagitis, acute gastritis, as well as events such as insertion of a gastric tube, endoscopic procedures, diabetic ketoacidosis, and uremia. Other precipitating factors encompass vigorous coughing, excessive alcohol consumption, strenuous defecation, heavy lifting, childbirth, severe hiccups during anesthesia, chest compressions (CPR), status asthmaticus, epileptic seizures, and blunt abdominal trauma.

Diagnosis relies first on medical history, particularly identifying factors that cause a sudden rise in gastric pressure; the presence of a hiatal hernia makes the syndrome more likely. The most effective diagnostic method currently is emergency endoscopy. Barium meal X-ray examination is of limited value, while celiac artery angiography can also aid in diagnosis. For minor bleeding, which is often self-limiting, management may involve irrigation with norepinephrine in saline solution introduced into the esophageal and gastric cavity to promote vasoconstriction of submucosal vessels. It is also recommended to perform hemostasis, such as electrocoagulation or photocoagulation, on the bleeding site during emergency endoscopic diagnosis. A minority of patients with significant, persistent bleeding may require surgical suture of the laceration for hemostasis. If the precipitating factors are eliminated, recurrence is generally unlikely after treatment.