THE MALLORY-WEISS SYNDROME: EVALUATION BY EARLY ENDOSCOPY OF ITS CLINICAL PICTURE AND ITS INCIDENCE IN UPPER GASTROINTESTINAL HEMORRHAGE.

Abstract

1. In a prospective study of upper gastrointestinal hemorrhage, 297 cases were examined endoscopically. Eight instances of gastric or esophageal tears were noted. Over the 29-month period during which the study was carried out, there were 49,760 admissions to this municipal teaching hospital. The incidence of gastroesophageal tears was 2.7% of all upper gastrointestinal bleeders and 0.016% of all admissions. 2. Early endoscopy was of great value in establishing a rapid and accurate diagnosis of the lesion. 3. In 2 instances bleeding did not result from the demonstrated tears, but was due to coexistent acute gastric erosions. 4. In 4 other cases, bleeding from the tear stopped spontaneously; one of these was operated electively for a nonbleeding duodenal ulcer. Surgical intervention for continued bleeding was necessary in 2 patients, one of whom died. 5. An initial conservative approach to therapy of the Mallory-Weiss syndrome is suggested, provided the diagnosis is ascertained by early esophagogastroscopy. Continued bleeding will obviously dictate surgical intervention.