Mallory Weiss tear As a Cause of Upper Gastrointestinal Bleeding

Mallory-Weiss Tear is a notable cause of non-variceal upper gastrointestinal bleeding (UGIB), accounting for approximately 5–15% of cases2. Here's a deep dive into its pathophysiology, presentation, and management:

🔍 Pathogenesis
A longitudinal mucosal laceration at the gastroesophageal junction or gastric cardia.

Caused by a sudden rise in intra-abdominal pressure, typically from:

Forceful or repeated retching or vomiting

Coughing, straining, or heavy lifting

Alcohol bingeing or bulimia nervosa

The tear disrupts submucosal vessels, leading to bleeding4.

🚨 Clinical Presentation
Hematemesis (vomiting bright red blood or coffee-ground material)

Melena (black, tarry stools)

Epigastric or retrosternal pain

Dizziness or syncope in severe cases

Often follows an episode of vomiting or retching4.

🔬 Diagnosis
Upper GI endoscopy is the gold standard:

Reveals a linear tear at the gastroesophageal junction

May show active bleeding, clot, or fibrin crust3

Labs: CBC, coagulation profile, and crossmatch for transfusion

💊 Management
Supportive care: IV fluids, blood transfusion if needed

Acid suppression: PPIs or H2 blockers to promote healing

Endoscopic therapy if bleeding persists:

Injection therapy (e.g., epinephrine)

Hemoclips, band ligation, or thermal coagulation

Angiographic embolization or surgery in refractory cases4

📉 Prognosis
Bleeding stops spontaneously in 80–90% of cases

Recurrence is rare but possible with repeated vomiting

Mortality is low unless complicated by shock or comorbidities3

#Bleeding

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