Mallory-Weiss tear
Mucosal tear at the gastro-oesophageal junction from a sudden rise in pressure (retching/vomiting)
Overview
A mucosal (partial-thickness) tear at the gastro-oesophageal junction caused by a sudden rise in intra-abdominal/intraluminal pressure — classically forceful retching or vomiting (alcohol binge, bulimia, hyperemesis), THEN haematemesis. Usually self-limiting and managed supportively. The key contrasts are with variceal bleeding (no liver disease) and Boerhaave (full-thickness rupture — much more dangerous).
Recognise
- A history of forceful RETCHING/VOMITING FIRST, then haematemesis (often small-volume, self-limiting)
- Precipitants: alcohol binge, bulimia, gastroenteritis, hyperemesis gravidarum
- Usually haemodynamically stable; the mucosal tear is at the GOJ on endoscopy
Red flags
- Significant/ongoing bleeding → endoscopic therapy
- Severe chest/abdominal pain + signs of sepsis after vomiting → suspect BOERHAAVE (full-thickness rupture) instead
Differentials & how to tell them apart
Investigations
As for upper GI bleed; ENDOSCOPY (shows the GOJ tear) if significant bleeding/diagnostic doubt. FBC, U&Es.
Management
Supportive care (resuscitate if needed); endoscopy if bleeding significant
- 1Resuscitate as needed; most Mallory-Weiss tears stop spontaneously. Endoscopy + haemostasis for significant/ongoing bleeding.Gate: Severe pain, fever and sepsis AFTER vomiting points to BOERHAAVE (full-thickness rupture/mediastinitis), not a benign Mallory-Weiss mucosal tear — that is a surgical emergency
- 2Endoscopic therapy for ongoing bleeding; address the precipitant (alcohol, bulimia, hyperemesis).
Key points
Retching/vomiting FIRST, then blood, usually self-limiting = Mallory-Weiss (a mucosal tear). The dangerous mimic is Boerhaave (full-thickness rupture + mediastinitis). No liver disease distinguishes it from varices.
Monitor & prognosis
Bleeding; precipitant.
Excellent; usually self-limiting.
Source: BSG; NICE CG141