Highlights & Basics
- Mallory-Weiss Tear (MWT) accounts for about 5% to 7% of people with upper gastrointestinal (GI) bleed.
- Commonly presents with hematemesis after an episode of forceful or recurrent retching, vomiting, coughing, or straining. Hematemesis can be intermittent or brisk.
- Patients can be assessed for risk using the Glasgow Blatchford Score (GBS). Low-risk patients can be discharged with outpatient follow-up. Patients with a GBS score of ≥2 should be admitted and have an esophagogastroduodenoscopy within 24 hours.
- MWT is mostly self limiting, so treatment is generally supportive. Emergency treatment is reserved for those showing signs or symptoms of instability or with evidence of active, ongoing bleeding.
- Esophagogastroduodenoscopy will usually provide a definitive diagnosis and the opportunity to treat active bleeding.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Bleeding Mallory Weiss Tear viewed on retroflexion
Mallory Weiss tear after application of through-the-scope clip results in hemostasis
Actively bleeding tear appears as a red longitudinal defect with normal surrounding mucosa
Epinephrine is injected intravenously next to Mallory-Weiss tear
Mallory-Weiss tear after epinephrine injection (the bleeding has stopped, allowing better visualization of the lesion)
A through-the-scope clip deployed in the center of the lesion (no previous epinephrine was infused in this case)
Nonbleeding adherent clot
Three through-the-scope clips deployed to complete closure of the mucosal defect
Citations
Alali AA, Barkun AN. An update on the management of non-variceal upper gastrointestinal bleeding. Gastroenterol Rep (Oxf). 2023 Mar 20;11:goad011.[Abstract][Full Text]
Laine L, Barkun AN, Saltzman JR, et al. ACG clinical guideline: upper gastrointestinal and ulcer bleeding. Am J Gastroenterol. 2021 May 1;116(5):899-917.[Abstract][Full Text]
Barkun AN, Almadi M, Kuipers EJ, et al. Management of nonvariceal upper gastrointestinal bleeding: guideline recommendations from the International Consensus Group. Ann Intern Med. 2019 Dec 3;171(11):805-22.[Abstract][Full Text]
American College of Radiology. ACR appropriateness criteria: nonvariceal upper gastrointestinal bleeding. 2024 [internet publication].[Full Text]
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