A laceration of the lower esophagus and the upper part of the stomach during forceful vomiting, retching, or hiccups is called a Mallory-Weiss tear. The tear may rupture blood vessels, which then bleed. Mallory-Weiss syndrome was initially described in people with an alcohol use disorder, but it can occur in anyone who vomits forcefully.
Mallory-Weiss syndrome is the cause of about 5% of bleeding episodes in the upper digestive tract (see also Gastrointestinal Bleeding).
Doctors suspect the diagnosis of Mallory-Weiss syndrome in people who have blood in their vomit after one or more episodes of vomiting. If the amount of bleeding is small, doctors may wait to do testing because the bleeding may stop on its own.
If the bleeding is severe or does not stop on its own, doctors do upper endoscopy. During upper endoscopy, doctors examine the esophagus using a flexible tube called an endoscope. Upper endoscopy allows doctors to see the bleeding source and often treat it at the same time.
If bleeding is rapid or severe, doctors sometimes do angiography. During angiography, doctors use a catheter to inject an artery with a liquid (contrast agent) that can be seen on x-rays.
Most bleeding episodes stop by themselves, but sometimes the doctor must do endoscopy and take measures to stop the bleeding. Measures include using heat to cauterize the bleeding blood vessel, clipping it closed, or injecting a drug into it.
Alternatively, the doctor may inject vasopressin or epinephrine into the bleeding blood vessel during angiography to stop the bleeding.
People who lose a lot of blood require a blood transfusion.
Surgery to repair the tear is rarely required.