Mallory-Weiss syndrome

Disease Description (Causes and Symptoms)

• Definition: A condition in which the mucosa at the area where the stomach and esophagus meet (the gastroesophageal junction) tears and causes bleeding. It mainly occurs after intense vomiting, retching, or increased intra-abdominal pressure.
• Pathophysiology: Repeated or explosive vomiting causes a rapid increase in intragastric (and intraesophageal) pressure, resulting in a mucosal tear at the gastroesophageal junction and injury to submucosal blood vessels, which causes bleeding. In some cases, the mucosa on the esophageal side may also rupture.
• Main causes: Repeated or intense vomiting (vomiting after heavy alcohol consumption, food poisoning, severe motion sickness, etc.), and situations involving increased intra-abdominal pressure such as intense coughing, seizures, and childbirth.
• Main symptoms: Hematemesis (bright red or black blood), nausea and vomiting (before or together with the bleeding), melena (bloody stool), and systemic symptoms caused by bleeding such as dizziness, tachycardia, and hypotension. Shock may occur in severe cases.
• Prevalence and epidemiology (summary): Accounts for approximately 5–10% of causes of upper gastrointestinal bleeding, is more common in men (approximately 4:1), and occurs most frequently in adults, particularly those in their 30s and 40s.

Treatment Methods and Precautions

• Initial emergency care (if bleeding is suspected)
  • Check vital signs (blood pressure, pulse, and respiration), secure intravenous access, and provide oxygen if necessary.
  • Fluid replacement (crystalloid solutions) and blood transfusion (in cases of hemodynamic instability or significant anemia).
  • Fasting and consideration of administration of an acid-suppressing medication (intravenous PPI).
  • Administration of antiemetics to prevent additional vomiting.
• Diagnostic and therapeutic endoscopy
  • Upper gastrointestinal endoscopy (endoscopy during the acute phase) is the basis for diagnosis and hemostasis.
  • Endoscopic hemostasis: Thermal therapy (cauterization), injection therapy (injection of tissue adhesive or diluted epinephrine), clips (clip ligation), and other methods. Rubber-band ligation or combination therapy may also be used recently.
• Interventional radiology and surgery
  • If hemostasis cannot be achieved by endoscopy or rebleeding persists, vascular embolization (interventional radiology) is possible.
  • In rare cases of persistent massive bleeding or full-thickness esophageal perforation, surgical treatment is necessary.
• Drug treatment
  • Intravenous PPI (to suppress bleeding and protect the gastric mucosa), antibiotics if necessary (when perforation is suspected), and antiemetics. Tranexamic acid is not standard treatment but may be considered in some situations (at the physician’s discretion).
• Follow-up observation and discharge instructions
  • In most cases, mucosal tears heal spontaneously within several days. After endoscopic hemostasis, patients may be discharged after observation if their condition is stable.
  • Visit a medical institution immediately if rebleeding occurs.
• Lifestyle management and precautions
  • If alcohol consumption caused the bleeding, abstinence from alcohol is recommended. Avoid medications and foods that cause vomiting or nausea.
  • If you are taking NSAIDs, anticoagulants, or antiplatelet drugs, consult your attending physician about temporarily stopping or adjusting them.
  • If emergency symptoms occur, such as vomiting a large amount of blood, decreased consciousness, chest pain, persistent melena, or fainting, visit an emergency department immediately.

Checklist Before an Outpatient Visit (Including Items to Bring and Example Questions)

• Recommended items to prepare and bring
  • A list of currently prescribed medications (including protocols: anticoagulants, antiplatelet drugs, NSAIDs, antidepressants, etc.)
  • Allergy history (medications, contrast media, etc.)
  • Past medical and surgical history (liver disease, cardiovascular disease, gastrointestinal surgery, etc.)
  • Recent symptom record: time and frequency of vomiting, color (including blood), stool color (black/bloody), and whether dizziness or fainting occurred
  • Copies of recent test results, if possible (blood tests, upper gastrointestinal endoscopy findings, etc.)
• Information to tell the doctor in advance during the outpatient visit
  • The frequency and amount of hematemesis/vomiting within the past 24–48 hours
  • Alcohol use history (whether there has been recent heavy drinking and the usual amount of alcohol consumed)
  • Whether you are taking anticoagulants (warfarin/DOACs) or antiplatelet drugs (aspirin, clopidogrel)
• Information that may be helpful to explain to the medical staff before the consultation
  • When the bleeding started and how it has progressed, along with accompanying symptoms (abdominal pain, fever, shortness of breath)
  • Whether you have had gastrointestinal bleeding in the past or have previous endoscopy findings

General Example Questions to Ask the Doctor

• "Could you explain exactly what is causing the bleeding right now?"
• "Is my condition one that requires emergency treatment, such as a blood transfusion or endoscopy?"
• "What are the side effects of the prescribed medication (for example, a PPI), and how long should I take it?"
• "When is the next follow-up endoscopy scheduled?"
• "Which foods, medications, or activities should I particularly avoid in daily life?"

Disease-Specific Example Questions

• "If the repeated vomiting continues, is the risk of rebleeding high? What measures do you recommend to reduce the risk of rebleeding?"
• "I am taking an anticoagulant (or antiplatelet drug). Do I need to stop taking it? What are the risks of stopping it, and what alternatives are available?"