Mallory-Weiss Syndrome: Retrospective Review of Ten Years’ Experience

Abstract

Background: Mallory-Weiss syndrome is known to cause 5-15% of upper gastrointestinal bleeding. The most common precipitating factor is known to vomit and retch related with a history of excessive drinking or physical findings consistent with chronic alcohol abuse. The bleeding stops spontaneously in 90% of patients, and these patients can be managed conservatively. Endoscopic therapy is required when there are active bleeding or presence of stigma of recurrent bleeding. This study reviews the experience 156 patients over a 10-yr period, and was designed to asses the clinical characteristics, the endoscopic findings and the therapeutic results of patients with endoscopically diagnosed Mallory-Weiss syndrome. Methods: Among 12521 cases of upper gastrointestinal bleeding from January 1995 to April 2005, 156 cases(1.24%) were diagnosed as Mallory-Weiss syndrome by endoscopy. We reviewed patient's medical records retrospectively. We assessed clinical characteristics, endoscopic findings and therapeutic results. Results: The mean age was 48.8 years and male:female ratio was 18.5:1. The frequent precipitating factor was vomiting developed after drinking (65%). In these patients (110 cases), 42 cases (38%) occurred in winter, 21 cases (19%) in spring, 31 cases (28%) in summer and 16 cases (15%) in fall. Endoscopic findings revealed active bleeding in 33 cases (21%), blood clot without active bleeding in 87 cases (56%), and scar change in 36 cases (23%). In 113 cases (72%), coexisting diseases such as gastritis, gastric ulcer and esophageal varix were detected. The Mallory-Weiss tears were located on gastric area in 25 cases (16%), on lower esophagus in 16 cases (10.4%), on gastroesophageal junction in 114 cases (73%), on gastroesophagus in 1 case (0.6%). As for the number of tears, one tear was most common in 120 cases (77%), two tears in 27 cases (17%) and three or more tears in 9 cases (6%). On the view of direction of tear, 69 cases were on anterior wall side, 39 cases were on posterior wall side, 43 cases on lesser curvature side and 32 cases were on great curvature side. 115 cases (74%) were treated with supportive care, 23 cases with epinephrine injection, 16 cases with epinephrine with ethanol injection and 2 cases with band ligation. Rebleeding was showed in 9 cases (6%). In cases of rebleeding, 5 cases were on anterior wall side. Conclusion: Mallory-Weiss syndrome is closely related with alcoholic intake. This study showed the incidence of Mallory-Weiss syndrome was lower than other study and more commonly developed at summer and winter. The bleeding stoped spontaneously in 74% of patients but endoscopic therapy was required in patient with risk factors.