Epidemiology
Data on incidence and outcome parameters such as in-hospital mortality are sparse. Two studies in the US showed an incidence of upper gastrointestinal (GI) hemorrhage of between 60 and 78 per 100,000 population in 2009.[6][7] In one German study based on standardized hospital discharge data provided by the German Federal Statistical Office between 2010 and 2019, an average of approximately 6000 patients per year had Mallory-Weiss tear (MWT), with an overall annual hospitalization incidence of 7.5/100,000 persons and an in-hospital mortality rate of 2.7%.[8] MWT represents approximately 5% to 7% of upper GI bleeding.[9] It is less common in children, who represent about 0.3% of upper GI bleeds.[10] MWT is more common in men than in women, in a ratio of 3:1.[11] In women of childbearing age, the most common cause is hyperemesis gravidarum.[12] MWT has no racial predilection. The age of presentation may vary but MWT is most common in people between ages 30 and 50 years.[10] Recurrent bleeding after an episode of MWT has been reported to occur in around 10% of patients.[13][14]
Risk factors
Conditions that may induce vomiting include: food poisoning, gastroenteritis, or any gastrointestinal condition resulting in obstruction; hepatitis, gallstones, and cholecystitis; hyperemesis gravidarum; urinary tract infection, renal failure, and ureteropelvic obstruction; brain tumors, hydrocephalus, congenital disease, trauma, meningitis, pseudotumor cerebri, migraine headaches, and seizures; anorexia nervosa, bulimia, and cyclic vomiting syndrome.[12][17][18][19] Toxins, polyethylene glycol lavage, chemotherapy agents, and postanesthesia or postsurgery are also causes.[20][21][22]
May be associated with whooping cough, bronchitis, bronchiectasis, emphysema, COPD, or lung cancer.[23]
Mucosal tear or laceration during a routine endoscopy is a rare event (0.0001% to 0.4% of cases).[24][25] However, it is considered to be the most common cause of iatrogenic tear or laceration.
Other procedures involving instrumentation that may be associated with esophageal tear or laceration include nasogastric or orogastric tube placement, endoscope band ligation, endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasound.[26]
Iatrogenic Mallory-Weiss tears are rare and generally have a benign course. They tend to occur mostly in patients who have experienced excessive retching, struggling during endoscopy, longer endoscope time, and excessive air inflow. They tend to occur in female patients, older patients, and those with hiatus hernias.[28][29]
More common in men than in women, in a ratio of 3:1.[11]
A sudden increase of intraluminal pressure against a closed glottis has been suggested as the main mechanism for development of Mallory-Weiss tear, although the pathogenesis is uncertain.[35] Blunt abdominal trauma is one of the mechanisms by which intraluminal pressure can increase.
Exact pathogenesis is uncertain, although compression of the esophagus between the sternum and the vertebrae is probably the most likely explanation.[36]
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