Summary

A Mallory-Weiss tear is a longitudinal mucosal laceration at or near the gastro-oesophageal junction (GOJ), caused by a sudden rise in intra-abdominal pressure, classically from forceful vomiting or retching. It typically presents with haematemesis following an episode of non-bloody vomiting or retching. The tear is mucosal/submucosal (NOT full thickness). It accounts for 5-15% of acute upper GI bleeds. Most tears stop bleeding spontaneously (90%), but endoscopic intervention may be required for ongoing haemorrhage. Prognosis is excellent. Mallory-Weiss must be distinguished from Boerhaave syndrome, which is a full-thickness oesophageal rupture and a surgical emergency.

Key Facts

• Location: Gastro-oesophageal junction (GOJ); may extend into gastric cardia
• Cause: Forceful vomiting, retching, coughing, straining
• Depth: Mucosal/submucosal (partial thickness)
• Classic History: Repeated retching → then haematemesis
• Diagnosis: Upper GI endoscopy (OGD)
• Treatment: 90% stop spontaneously; Endoscopic therapy if persistent
• Key Differential: Boerhaave syndrome (full thickness perforation)

Clinical Pearls

"Retching First, Blood Later": The classic history is initial non-bloody vomiting followed by haematemesis. This distinguishes Mallory-Weiss from variceal or ulcer bleeding.

"Mallory-Weiss Bleeds, Boerhaave Perforates": Mallory-Weiss is a mucosal tear (bleeding). Boerhaave is a full-thickness rupture (chest pain, mediastinitis, surgical emergency). Know the difference.

"Alcohol is the Classic Precipitant": Binge drinking followed by prolonged vomiting is the classic scenario. But any forceful vomiting can cause it.

"Most Stop Spontaneously": 90% of Mallory-Weiss tears stop bleeding without intervention. Only 10% need endoscopic or surgical treatment.

General

• May appear well if self-limiting
• Signs of hypovolaemia if significant bleed (tachycardia, hypotension, pallor)

Abdominal

• Mild epigastric tenderness
• No peritonism (unless perforation)

Look for

• Signs of chronic liver disease (if alcohol-related)
• Subcutaneous emphysema (neck/chest) - suggests Boerhaave

Risk Stratification

• Use Glasgow-Blatchford Score or Rockall Score
• Assess haemodynamic status

Natural History

• 90% of tears stop bleeding spontaneously
• Healing occurs within 48-72 hours

With Treatment

• Endoscopic therapy: >95% success rate
• Surgical intervention: Rarely needed (<5%)

Recurrence

• Uncommon unless precipitating cause persists (e.g., ongoing vomiting)

Factors Affecting Outcome

Key Guidelines

1. BSG Guidelines: Management of Acute Upper GI Bleeding
2. NICE NG141: Acute Upper GI Bleeding

Key Evidence

Natural History

• Studies show 80-90% spontaneous haemostasis
• Endoscopic therapy effective for ongoing bleed

Endoscopic Therapy

• Haemoclips and injection are effective
• Combination therapy may be superior to monotherapy

What is a Mallory-Weiss Tear?

A Mallory-Weiss tear is a small tear in the lining of the food pipe (oesophagus) just where it joins the stomach. It happens when you vomit or retch very forcefully, which puts pressure on this area and causes it to tear slightly.

What Are the Symptoms?

• Vomiting blood (bright red) after repeated retching
• Usually starts with normal vomiting, then blood appears
• Sometimes mild pain in the upper tummy

Is it Serious?

Most of the time, no. About 9 out of 10 people stop bleeding on their own without needing any specific treatment. Occasionally, a small procedure is needed to stop the bleeding.

A more serious condition called Boerhaave syndrome can also happen if the tear goes all the way through - but this is rare and would cause severe chest pain.

How is it Diagnosed and Treated?

• Diagnosis: A camera test (endoscopy) looks at the tear
• Treatment: Usually just supportive care (fluids, anti-sickness medication)
• If still bleeding, clips or injections can be used through the camera

How Long to Recover?

The tear usually heals within a couple of days. You'll be advised to avoid alcohol and take medication to reduce stomach acid.