Where is a Mallory-Weiss tear typically located?

From the Guidelines

A Mallory-Weiss tear is located on the greater curve of the cardia, or more specifically, it can be described as being located on the mucosal surface, often on the lesser curve but also on the greater curve, near the gastroesophageal junction, making option (e) a potentially correct description in the context of the greater curve, but the most accurate description based on common locations would be option (b) or (e), with (e) being the choice that matches the greater curve description. This condition involves a longitudinal mucosal laceration that typically occurs at the gastroesophageal junction, predominantly on the lesser curve but can also occur on the greater curve [ 1 ]. Mallory-Weiss tears commonly result from forceful vomiting, retching, or coughing that creates a sudden increase in intra-abdominal pressure. The increased pressure, combined with the anatomical configuration at the gastroesophageal junction, causes the mucosa to tear along the wall where tissue is more vulnerable to stretching forces. These tears typically present with hematemesis (vomiting blood) following episodes of forceful vomiting. Most Mallory-Weiss tears are self-limiting and heal spontaneously, though some may require endoscopic intervention if bleeding is severe or persistent, as noted in guidelines for non-variceal upper gastrointestinal haemorrhage [ 1 ]. Understanding the precise anatomical location helps in proper diagnosis and management of this condition.

Key Points:

• Mallory-Weiss tears are longitudinal mucosal lacerations.
• They typically occur at the gastroesophageal junction.
• The tears can be located on either the lesser or greater curve, but option (e) specifically mentions the greater curve.
• Forceful vomiting, retching, or coughing are common causes.
• Most tears heal spontaneously, but some may require endoscopic therapy for severe or persistent bleeding, as indicated by guidelines [ 1 ].

Management Considerations:

• Endoscopic injection using adrenaline or thermal methods are almost always effective for treating Mallory-Weiss tears [ 1 ].
• The choice between different endoscopic therapies depends on the specific clinical scenario and the expertise available.
• The primary goal is to achieve hemostasis and prevent further bleeding, thereby reducing morbidity and mortality associated with the condition.

From the Research

Mallory-Weiss Tear Location

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 the 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 occurring only on the esophageal side 3.
• Mallory-Weiss tears are typically located at the gastroesophageal junction 4.

Possible Locations

Based on the provided options:

• Option (b) anteriorly across the gastroesophageal junction is not the most common location.
• Option (c) posteriorly across the gastroesophageal junction is not specified in the studies.
• Option (d) on the lesser curve of the cardia is a common location for Mallory-Weiss tears 2.
• Option (e) on the greater curve of the cardia is not specified as a common location in the studies.
• Option (a) in the distal esophagus is not the most common location, but tears can occur in the right lateral wall of the esophagus 2.

Summary of Findings

The most common location of a Mallory-Weiss tear is:

• On the lesser curve of the cardia 2.
• At the gastroesophageal junction 3, 4.