From the Guidelines
A Mallory-Weiss tear is located posteriorly across the gastroesophageal junction, making option (c) the correct answer. The location of a Mallory-Weiss tear is critical in understanding its pathophysiology and management. According to the guidelines for non-variceal upper gastrointestinal haemorrhage 1, Mallory-Weiss tears are characterized by longitudinal mucosal lacerations that occur at the gastroesophageal junction. Key characteristics of Mallory-Weiss tears include:
- Typically develop as a result of forceful vomiting, retching, or coughing
- Increased intra-abdominal pressure forces gastric contents against a closed glottis, causing mucosal tear
- Posterior location experiences the greatest mechanical stress during these episodes
- Characterized by hematemesis, which is typically not severe and often self-limiting
- Diagnosis is usually confirmed by endoscopy, revealing linear mucosal lacerations at the gastroesophageal junction without evidence of ulceration In terms of management, endoscopic therapy may be necessary to arrest severe haemorrhage, with options including endoscopic injection using adrenaline or thermal methods, which are almost always effective 1.
From the Research
Location of Mallory-Weiss Tear
The location of a Mallory-Weiss tear can be identified based on the following evidence:
- Mallory-Weiss tears are most frequently located in the lesser curvature of the stomach and right lateral wall (2-to 4-o'clock position) of the esophagus, irrespective of the cause 2
- The tear is mainly located on the cardia part of the stomach side and spanning across the esophagogastric mucosal junction, with rare cases only on the esophageal side 3
- Mallory-Weiss tears are typically located at the gastroesophageal junction 4
- The tear is diagnosed when it shows a longitudinal mucosal tear at the esophagogastric junction 5
- A Mallory-Weiss tear is a mucosal laceration occurring at or near the esophagogastric junction 6
Possible Answers
Based on the evidence, the possible answers are:
- (b) anteriorly across the gastroesophageal junction
- (d) on the lesser curve of the cardia
- (e) on the greater curve of the cardia (less likely) Note that the exact location may vary, but the most common locations are near the gastroesophageal junction, on the lesser curve of the cardia, or spanning across the esophagogastric mucosal junction.