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.