A Retrospective Analysis and a New Type of Clinical Classification of Mallory-Weiss Syndrome

Abstract

Introduction: Mallory-Weiss Syndrome (MWS) is one of the important causes of upper gastrointestinal bleeding and it is mainly induced by severe vomiting. Now the causes of MWS have changed partly and the treatment of which has almost turned to endoscopic therapy. A new type of clinical classification may be helpful for the evaluation of MWS. Methods: Retrospective analysis of 64 MWS cases in our hospital from January 2010 to March 2014. The causes, endoscopic findings, treatment and prognosis were evaluated according to a new type of clinical classification. Results: The ratio of male to female in 64 MWS cases is 3.3:1 and the average age is 50.2 years old. 53.1% of MWS is caused by over drinking or inappropriate diet occasionally. 37.5% of MWS is caused by underlying gastric diseases such as peptic ulcer (26.6%), gastric cancer (6.3%) or Dieulafoy disease (4.7%). And 9.4% of MWS is caused by endoscopic examination or treatment. 62.5% of MWS developed only one lesion of cardia and/or lower esophagus and 29.7% developed 2˜3 lesions. The lesions may happen in all the four walls of cardia and/or lower esophagus and the right wall is relatively common location (32.5%). According to a new type of clinical classification introduced here during endoscopic examination, 17.2% of MWS was found out with active bleeding (Type A) such as spouting, pulsating or oozing. 21.9% was found out with fresh blood clot (Type B) and 32.8% with old blood clot (Type C). The rest 28.1% was found with line ulcer or scar (Type D). All Type A patients were treated with endoscopic metal clip treatment and partly combined with noradrenalin spraying. Part of Type B patients were treated with metal clip or noradrenalin spraying. Only one patient of Type A died because of suspected underlying intestinal bleeding and all other patients were cured. Conclusion: Underlying gastric diseases are also important causes of MWS and easy to be ignored especially Dieulafoy disease. Endoscopic metal clip is the first choice for treatment of MWS and the new type of clinical classification is useful for evaluation.