Mallory-Weiss Tear

Mallory-Weiss tears are longitudinal mucosal lacerations at the gastroesophageal junction, classically following forceful vomiting, retching, or coughing. They account for approximately 5–10% of upper GI bleeding presentations. The mucosal disruption typically extends from the cardia toward the distal esophagus and may bleed briskly when a submucosal vessel is exposed.

Most tears stop bleeding spontaneously and require only supportive care. Endoscopic intervention is reserved for active bleeding, visible vessels, or recurrent bleeding. Through-the-scope hemoclips are first-line — placed perpendicular to the tear, starting at the distal end and moving proximally to recreate a stable Y-shape closure. Band ligation is an alternative; epinephrine injection alone is inadequate but useful as an adjunct to slow bleeding and improve visualization.

Risk factors include alcohol use, hiatal hernia, NSAID use, and chronic vomiting (bulimia, hyperemesis). Recurrence after definitive endoscopic therapy is uncommon, and recurrence within the same admission should prompt re-evaluation for an alternative or coexisting source such as a peptic ulcer or Dieulafoy lesion.