Frequency, Significance and Therapy of the Mallory–Weiss Syndrome in Patients With Portal Hypertension

Abstract

The files of patients who underwent emergency endoscopy in a 2-yr period (January 1985 to January 1987) in the Heinz-Kalk Hospital were analyzed to establish the frequency, significance and therapy of the Mallory-Weiss syndrome associated with portal hypertension, an association observed in 55 of 339 patients (16.2%). Portal hypertension was caused by cirrhosis in 53 patients and by a prehepatic block in two patients. For 21 of these patients (37%) with portal hypertension, Mallory-Weiss syndrome was the first bleeding manifestation. They numbered 6.2% of the whole population. In the remaining 34 patients (63%) sclerotherapy treatment had been previously performed. No lesions that suggested peptic esophagitis were seen in these 55 patients, although in 25 of them (45.4%) a gastroesophageal reflux was observed. The frequency of bleeding from a Mallory-Weiss tear was significantly higher in patients with advanced liver disease, particularly with Child-Pugh classifications C and B. In patients with prehepatic block, a hemorrhage from a Mallory-Weiss tear may occur, but the frequency is significantly lower than it is in patients with cirrhosis. The bleeding tear was treated by transendoscopic esophageal and cardial wall sclerosis (paravariceal technique) and was, in all cases, successfully controlled. Mallory-Weiss syndrome is observed more frequently in patients with portal hypertension and cirrhosis. Gastroesophageal reflux apparently does not play a major role in the pathogenesis of this syndrome. It may simply be the manifestation of an abnormal gastroesophageal function. Mallory-Weiss syndrome can also be observed as a cause of rebleeding in patients treated with chronic sclerotherapy. Paravariceal endoscopic sclerotherapy is apparently the treatment of first choice to stop hemorrhage.

Mallory–Weiss syndrome in children

“…Our results of a 0.3% incidence of Mallory–Weiss syndrome in children is similar to the value of 0.1% reported by Penston et al 8 Similarly, in our series in the incidence of upper gastrointestinal bleeding was 12.9%, which is similar to the value obtained by Paguet et al (15%) 19 …”

“…Our results of a 0.3% incidence of Mallory±Weiss syndrome in children is similar to the value of 0.1% reported by Penston et al 8 Similarly, in our series in the incidence of upper gastrointestinal bleeding was 12.9%, which is similar to the value obtained by Paguet et al (15%). 19 It should be stressed that during upper gastrointestinal endoscopy in patients with Mallory±Weiss syndrome no signs of active bleeding were observed. Similarly, Di Felice, 6 while analyzing 61 cases with this disease, observed active bleeding in only 3% patients.…”

Total shunting and elective management of variceal bleeding

“…Analysis of late results reported in the literature does not show a clear advantage for other shunts over total portosystemic shunts. Neither long-term survival nor rebleeding rates differ from other series [11,[15][16][17][18][19][20]26].…”

Mallory-Weiss sendromunun argon plazma koagülasyonu ile tedavisi

“…Many conditions have been noted to have an association with MWS, including chronic and/or binge alcohol use (1,2). Other associations described previously include the presence of a hiatus hernia, non-steroidal anti-inflammatory agent use, portal hypertension, other mucosal pathologies, upper endoscopy, and prolonged coughing or paroxysms of coughing (3,4).…”