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At a glance

It is a sporadic condition characterized by esophageal bleeding at the gastrointestinal junction that is caused by a mucosal tear or laceration as a result of forceful or prolonged vomiting. Severe bleeding may result and in very rare cases, the bleeding may become life-threatening. A rapid intervention to stop bleeding may be needed.

History

It was first described in 1929 by George Kenneth Mallory and Soma Weiss, both American physicians.

Incidence

It is uncommon in children. It is responsible for 11 to 13% of significant upper gastrointestinal bleedings in adults. It occurs more frequently in individuals with alcoholism. The prevalence is higher in males than females. The ages of those affected varies considerably, with a peak between the ages of 40 and 60 years. However, some cases have been reported in children after severe vomiting.

Genetic inheritance

There is no genetic component to this medical condition.

Pathophysiology

Prolonged or forceful vomiting can increase intraesophageal pressure significantly. This may result in lacerations, usually at the gastroesophageal junction. In adults, the tears are usually confined to the gastroesophageal junction (49%) but may extend into the esophagus (15%) and stomach (33%). Significant bleeding is unusual and is most likely to occur if the tear extends into the vascular cardia.

Diagnosis

Endoscopy of the upper gastrointestinal tracts reveals superficial, longitudinal tears in the esophageal mucosa in the acute phase. Granulation tissue forms later, and the lesion may appear as a white raised streak.

Clinical aspects

Patients usually present with hematemesis after an episode of acute, severe and prolonged vomiting. Bleeding is usually painless and is rarely significant enough to require blood transfusion. In children, specific treatment is rarely required. If bleeding persists, then treatment modalities include vasopressin, angiographic-guided embolization, and, rarely, surgical control of the bleeding. Pediatric patients usually require anesthesia for endoscopy.

Precautions before anesthesia

Careful history to determine cause of vomiting and the extent of bleeding. Blood examination: hemoglobin to determine blood loss; blood transfusion if necessary. Consider patient to have full stomach, particularly if bleeding has been extensive.

Anesthetic considerations

Correction of anemia and hypovolemia if necessary. Rapid-sequence induction.

Pharmacological implications

May require perioperative antiemetic therapy.

Other conditions to be considered

  • Zollinger-Ellison Syndrome: Rare medical condition characterized by small pancreatic tumors, increased secretion of gastric acids causing ulcers. The tumors can also appear been seen in the stomach, spleen, or gastric lymph nodes. Prompt medical treatment is recommended to prevent bleeding and gastric wall perforation.

  • Chronic Erosive Gastritis: Frequent medical condition associated with gastric inflammation causing ulcer-like symptoms. Clinically, anemia can ...

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