The Blatchford score is an useful index in the management of Mallory-Weiss tear and gastrointestinal bleeding: experience from an urban community hospital.

OBJECTIVES: The purpose of this study was to determine the utility of individual clinical parameters as well as a composite index like the Blatchford score in predicting the need for endoscopic intervention and prognosticating the out come in patients with Mallory Weiss tear presenting with gastrointestinal bleeding. METHODS: We retrospectively reviewed our endoscopy database and our EMR system to identify patients with Mallory Weiss tear and collect relevant data. RESULTS: A total of 38 cases with Mallory-Weiss tear were identified at our center over a 5 year period. Thirty-two patients presented with gastrointestinal bleeding constituting 3.1% of all cases presenting with upper gastrointestinal bleeding. Nine (28%) of 32 patients were found to have active bleeding or stigmata of recent bleeding at endoscopy and required endoscopic therapy. The Blatchford score ranged from 0 to 11 in the patients with gastrointestinal bleeding. Nine patients had a Blatchford score < 6 (four 0, five 1-4) while 23 patients had a score > 6. None of the patients with a score < 6 required endoscopic intervention or a blood transfusion while 9 (39%) patients with a score > 6 required endoscopic intervention and 17 (74%) required a blood transfusion. Length of stay was significantly longer in patients with a score > 6. CONCLUSIONS: The Blatchford score can be a useful index to risk stratify patients with Mallory Weiss tear who present with gastrointestinal bleeding with regards to hospital admission and identifying patients who warrant urgent endoscopic intervention, require blood transfusion and are likely to have a longer length of stay.

[Endoscopic methods of hemostasis in treatment of Mallory-Weiss syndrome].

Results of treatment of Mallory-Weiss syndrome using endoscopic methods of hemostasis in 549 patients were analyzed. The patients were divided into two groups: in 2000-2004 years without endoscopic methods, in 2004-2008 years using the endoscopic methods in the diagnostics and treatment. Considerably decreased operative activity and death rate was established in cases of treatment with endoscopic methods.

[Etiology and pathogenesis of Mallory-Weiss syndrome].

Treatment results of 405 patients with Mallory-Weiss syndrome, X-ray gastric investigation in patients with severe bloating reflex were analyzed. Experimental part of the study involved rats and pigs, modeling esophageal and gastric rupture. Cardioesophageal and gastric cardial rupture happen in case of simultaneous sudden intragastric and intraabdominal hypertension, following the rule of Laplace.

Mallory-Weiss tear: predisposing factors and predictors of a complicated course.

OBJECTIVES: Little has been published regarding predictors of a complicated course after Mallory-Weiss tear (MWT). The aims of this study were to identify risk factors for a Mallory-Weiss tear and factors predictive of a complicated course. METHODS: At our university hospital, we searched a computerized endoscopy database. At our Veterans Affairs hospital we manually searched printed endoscopy reports. Proposed risk factors for MWT were: history of alcohol use, recent alcohol binge, nonbloody initial emesis, anticoagulation, other coagulopathy, nonsteroidal anti-inflammatory use, and hiatal hernia. Proposed predictors of a complicated course were: age, hematemesis, melena, hematochezia, visible vessel, adherent clot, active bleeding, multiple tears, other pathology at endoscopy, admission Hct, hypotension or orthostatic changes, and coagulopathy. A complicated course was defined on the basis of >6 U of blood transfused, rebleeding, angiography, surgery, or death. Predictors of a complicated course were evaluated using the Mann-Whitney U test or Fisher exact test. RESULTS: A total of 73 cases were reviewed. The most common risk factor was alcohol use, which was found in 44% of cases. In all, 23% of patients had no risk factors. Of the patients, 17 (23%) had a complicated course. Patients with a complicated course had a lower admission Hct (p = 0.009) and active bleeding at initial endoscopy (p = 0.013). CONCLUSION: The predictive value of active bleeding supports early endoscopy for stratification and intervention.

[The optimization of treatment outcomes in patients with the Mallory-Weiss syndrome]. / K optimizatsii iskhodov lecheniia bol'nykh s sindromom Mallori--Veisa.

Examined in the study were results of conservative and surgical treatment of 202 patients presenting with Mallory-Weiss syndrome. Etiological factors of the syndrome were studied, investigations designed to study the regional bloodflow of the stomach in the zone of ruptures and intact areas, the motor and acid-producing functions of the stomach were conducted. Based on the conducted general clinical and special examination of patients with Mallory-Weiss syndrome the importance was proved of ischemic atrophic gastritis, discoordination of the motor and evacuatory function of the esophagus and duodenum in the genesis of the above syndrome, which disorders tend to be more manifest in sudden impacts of predisposing factors. In this connection, an etiopathogenetic approach has been developed towards treating patients such as mentioned above. Surgical treatment was being undertaken only when specifically indicated.

Endoscopic sclerotherapy in upper gastrointestinal bleeding due to the Mallory-Weiss syndrome.

OBJECTIVES: Therapeutic endoscopic techniques have changed the need for emergency surgery in gastrointestinal bleeding episodes. However, there is only little information about endoscopic therapies in severe gastrointestinal bleeding due to the Mallory-Weiss syndrome. The aim of this clinical study was to assess the usefulness of early endoscopic examination and sclerotherapy for severe or recurrent bleeding due to the Mallory-Weiss syndrome. METHODS: We studied all 50 cases of gastrointestinal bleeding secondary to the Mallory-Weiss syndrome seen in 2175 consecutive emergency endoscopic examinations performed in a University Hospital over a 3-year period. Endoscopic sclerotherapy (1/10000 adrenaline + 1% polidocanol) was performed in all patients with active bleeding or visible vessel at endoscopic examination. The remaining patients were medically treated. RESULTS: Active bleeding or a visible vessel were found in 13 patients; definitive hemostasis was obtained in all cases with sclerotherapy. The remaining 37 patients were successfully treated by conservative therapy. On admission, the severity of the hemorrhagic episodes was significantly higher in patients treated with sclerotherapy than in those who did not require this procedure. An esophageal perforation, successfully managed by conservative means, was the only complication recorded in the subset of patients undergoing sclerotherapy. CONCLUSIONS: Severe bleeding due to Mallory-Weiss syndrome can be successfully treated by sclerotherapy. Early endoscopic examination is an accurate procedure in identifying patients who do not require sclerotherapy.

The influence of liver disease and portal hypertension on bleeding in Mallory-Weiss syndrome.

The records of 79 patients admitted to the hospital from January 1985 through December 1990 for acute esophageal hemorrhage were analyzed to determine the influence of liver disease and/or portal hypertension on the severity of bleeding from Mallory-Weiss syndrome. Forty-two patients had bled from Mallory-Weiss syndrome; 8 had liver disease and nonbleeding esophageal varices, 6 had liver disease without varices, and 28 had no evidence of liver disease. The severity of bleeding was determined by the transfusion requirement for each group. The number of units of blood needed for patients with liver disease was significantly increased (p < 0.005) over the number of units necessary for patients without liver disease. There was no statistically significant difference in the transfusion requirement between liver disease patients with and without varices (i.e., portal hypertension). The transfusion requirement was also unrelated to the Child classification of hepatic functional reserve. We conclude that the severity of bleeding from Mallory-Weiss syndrome is primarily related to the status of liver function and that portal hypertension does not make an additive contribution.

Superior mesenteric artery blood flow in man measured with intra-arterial Doppler catheters: effect of octreotide.

Changes in splanchnic blood flow are important in the pathogenesis of portal hypertension, but research in this area is hampered by the difficulty in measuring splanchnic arterial blood flow in man. We therefore investigated the use of intra-arterial Doppler catheters in measuring superior mesenteric artery blood flow in man and assessed the effect of intravenous octreotide on superior mesenteric artery blood flow in a placebo-controlled double-blind study. Nine experiments were performed in a flow model using vessels with internal diameters of 6.5, 4.5 and 3.0 mm, with flow rates ranging from 50 to 700 ml/min. In this model the catheters gave instantaneous, reproducible measurements of blood flow in vessels of 6.5 mm internal diameter with a mean error ranging from +5.3% to +36.4%, compared to electromagnetic flowmetry, but were less accurate in smaller vessels. When used in patients, the catheters provided stable, reproducible measurements of superior mesenteric blood flow, in 16 out of 20 patients studied. In a double-blind placebo-controlled study, including 12 subjects, superior mesenteric artery blood flow was significantly reduced in patients receiving octreotide. We suggest that measurement of splanchnic arterial blood flow using intra-arterial Doppler catheters may be a useful additional investigation in the assessment of splanchnic vascular pathophysiology and pharmacology in man.

Hemorragia digestiva alta / Upper digestive bleeding

En los ultimos cinco anos se han presentado una serie de avances en el diagnostico y tratamiento de la hemorragia digestiva alta. La presente revision hace enfasis en entidades recientemente descritas o poco conocidas que pueden causar hemorragia, en los criterios clinicos y endoscopicos que permiten identificar los pacientes de alto riesgo y en los nuevos procedimeintos terapeuticos aplicables por via endoscopica. Asimismo se analizan de manera critica las formas tradicionales de tratamiento, como el lavado gastrico, que adolecen de soporte cientifico serio para justificar su utilidad

Mallory-Weiss syndrome associated with raised intracranial pressure.

A case of Mallory-Weiss syndrome associated with raised intracranial pressure resulting from metastatic brain tumor is reported for the first time. Relevant literature is reviewed and possible causes of Mallory-Weiss syndrome are discussed.

Síndrome de mallory-weiss: revisäo de 130 casos do Centro de Hemorragia Digestiva do Hospital do Andaraí

Os autores fizeram uma revisäo de 130 paciente internados no C.H.D. do Hospital do Andaraí, portadores de Síndrome de Mallory-Weiss, comparando sua experiência com a da literatura internacional

Mallory-Weiss syndrome. Experience in a community hospital.

The Mallory-Weiss syndrome is characterized by repeated bouts of retching and/or vomiting followed by the sudden onset of hematemesis or melena. Bleeding arises from linear, nonperforating mucosal lacerations at the cardia, cardioesophageal junction, distal esophagus, or a combination of these sites. Hiatal hernia is often a coexisting finding. Severity of hemorrhage can vary from mild to severe (100 to 2,000 ml). The clinical course is usually benign. The diagnosis can be suspected from the history and confirmed by upper gastrointestinal endoscopy. In the majority of patients, medical management controls the bleeding. About 10% to 20% of unselected patients require surgical intervention. With the proper, prompt use of fiberoptic endoscopy in the diagnosis of upper gastrointestinal hemorrhage has come an increase in the number of cases of Mallory-Weiss syndrome being identified. This is true even in community hospitals. The result has been a decrease in surgical intervention and overall mortality.

Upper gastrointestinal bleeding in a quadriplegic patient.

This paper presents an unusual case of gastrointestinal (GI) bleeding which followed a period of nausea and vomiting in a quadriplegic patient in whom endoscopy revealed a tear in the distal esophagus. Similar lesions have been described as the Mallory-Weiss syndrome. The physiology of vomiting is presented, wherein abdominal muscle contraction plays a partial role. The pathophysiology in the patient who lacks functional abdominal muscles is considered in relation to etiology. It is suggested that mucosal tears similar to those associated with a Mallory-Weiss syndrome be added to the differential diagnosis of upper GI bleeding in quadriplegic patients.

[Mallory-Weiss syndrome. A study of 25 cases (author's transl)]. / Le syndrome de Mallory-Weiss.

Twenty five cases of Mallory-Weiss syndrome were visualised endoscopically, representing, 4,6 p.cent of a serie of 540 consecutive upper gastro-intestinal bleedings. More frequent in men (85%) the mucosal laceration of the oesogastric junction caracteristic of the Mallory-Weiss syndrome is caused by a sudded intra-abdominal hyperpression. The lession is often associated with a prodrome of vomiting (80%). A hiatal hernia (80%), the ingestion of gastrotoxic drugs (52%) or of excessive alcohol (28%) are favorising factors. Emergency endoscopy allows an accurate diagnosis. The severity of the gastro-intestinal bleeding is generally not important and most patient can be managed non surgically.

The Mallory-Weiss-syndrome: a clinical study of 20 cases.

This is an account of 20 cases of MWS, representing 8% of a series of 247 consecutive upper GI-bleedings. Men above 40 years and persons with severe concomitant disease are specially at risk. The prognosis is rather good, mortality from bleeding being 10%. Surgery should not be undertaken unless all conservative measures, including vasopressin infusion and even Sengstaken-Blakemore tube have been applied. The typical history, a hiatal hernia and alcohol intake are frequently missing. Neither studies of gastric acid secretion nor esophageal manometry disclosed new pathogenic aspects.