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The mystery of Mallory-Weiss syndrome: Why can high pressure cause esophageal tears?
Mallory-Weiss syndrome is a condition in which high intra-abdominal pressure causes tears and bleeding in the esophageal mucosa. These tears are often called Mallory-Weiss tears. This syndrome is one of the common causes of acute upper gastrointestinal bleeding, accounting for about 1-15% of cases in adults and less than 5% in children. Studies have found that tears occur two to four times more often in men than in women. These tears mainly occur where the esophagus meets the stomach, called the gastroesophageal junction, but can occur anywhere from the middle of the esophagus to the lesser curvature of the stomach.
"Mallory-Weiss syndrome is often caused by prolonged vomiting and nausea."
Common causes of the condition include alcoholism and anorexia. Gastroesophageal reflux disease (GERD) is also a risk factor associated with Mallory-Weiss syndrome. However, not all individuals with Mallory-Weiss syndrome have these risk factors.
Historical BackgroundBleeding symptoms similar to those of Mallory-Weiss syndrome had been reported prior to 1929. The earliest report was published in 1833 by Johann Friedrich Hermann Albers during an autopsy, but that was bleeding from an ulcer, not a laceration. Then in 1879, Dr. Heinrich Quincke found three cases of bleeding caused by ulcer formation and noted that two of the cases resulted in death due to vomiting blood. In 1929, G. Kenneth Mallory and Soma Weiss accurately described the condition and first named it Mallory-Weiss syndrome, observing signs consistent with this symptom in 15 patients with a history of alcoholism.
Symptoms and Diagnosis
Mallory-Weiss syndrome is typically manifested by hematemesis (bloody vomitus) after vigorous vomiting, but may also present as old blood in the stool (melena) or in the absence of a history of vomiting. Often, vomiting blood is accompanied by pain in the chest, back, or upper abdomen. Although lacerations heal spontaneously in 90% of cases, in cases where bleeding is persistent or severe, endoscopy or surgery may be required to stop the bleeding.
"Upper endoscopy is necessary to confirm the diagnosis of a Mallory-Weiss tear."
Analysis of the cause
The causes of Mallory-Weiss syndrome are mainly related to alcoholism, eating disorders such as anorexia, and GERD. Studies have shown that up to 75% of patients have alcohol problems. In a 1989 study, 75% of people with Mallory-Weiss syndrome had a hiatal hernia, but a 2017 study disproved this association. This suggests that while tearing is primarily caused by severe vomiting, other factors may also contribute to the symptom.
Treatment methods
Treatment of Mallory-Weiss syndrome depends on the amount and extent of bleeding. Although 90% of lacerations can heal naturally, if bleeding is significant, endoscopic hemostasis techniques are required, including metal clipping, thermal probe coagulation, injection therapy, etc. It has been proven that if hemostasis methods are ineffective, further interventional treatments such as arterial embolization may be required.
Potential complications"The main symptoms of gastrointestinal bleeding include vomiting blood and loss of consciousness."
While Mallory-Weiss syndrome is rarely fatal, in some cases patients may experience shock symptoms, which require emergency treatment. In particular, insufficient blood volume caused by prolonged vomiting may cause blood circulation problems and require immediate anti-shock treatment.
Wise men have said that the danger of esophageal laceration is not only a temporary physiological phenomenon, but is also closely related to lifestyle choices. In modern society, how can we balance the stress and health risks in our lives so as not to fall into the trap of Mallory-Weiss syndrome?
