From the Guidelines
Mallory-Weiss syndrome treatment primarily involves supportive care and endoscopic therapy for active bleeding, with proton pump inhibitors administered to reduce gastric acid and promote healing. The initial management of Mallory-Weiss syndrome focuses on hemodynamic stabilization with intravenous fluids or blood transfusions if bleeding is severe. For active bleeding, endoscopic therapy is the first-line treatment, typically using techniques such as epinephrine injection (1:10,000 dilution), thermal coagulation, or mechanical methods like hemoclips, as indicated by the guidelines for non-variceal upper gastrointestinal haemorrhage 1. Some key points to consider in the treatment of Mallory-Weiss syndrome include:
- Endoscopic injection using adrenaline or thermal methods are almost always effective for Mallory-Weiss tears, which almost always stop bleeding spontaneously but occasional endoscopic therapy is needed to arrest severe haemorrhage 1
- Proton pump inhibitors (such as pantoprazole 40mg IV twice daily or omeprazole 40mg IV twice daily) are administered to reduce gastric acid and promote healing, and are definitely indicated for acute/short-term use in the treatment of Mallory-Weiss tears 1
- Patients should avoid NSAIDs, alcohol, and other potential gastric irritants during recovery
- If endoscopic treatment fails, angiographic embolization or surgical intervention may be necessary, though this is rare
- The underlying cause of vomiting or retching should be addressed to prevent recurrence Most patients with Mallory-Weiss tears have excellent outcomes with appropriate treatment, as the mucosal tear typically involves only the superficial layers of the gastroesophageal junction or proximal stomach.
From the Research
Treatment Options for Mallory-Weiss Syndrome
The treatment for Mallory-Weiss syndrome typically involves endoscopic management to stop the bleeding, especially in cases with active bleeding or stigmata of recurrent bleeding 2. The most commonly used endoscopic treatments include:
- Injection therapy
- Argon plasma coagulation
- Hemoclip placement
- Band ligation
Effectiveness of Endoscopic Treatments
Studies have shown that endoscopic hemoclip placement and epinephrine injection are equally effective and safe for managing active bleeding in Mallory-Weiss syndrome, even in patients with shock or comorbid diseases 3. Band ligation has also been found to be an efficient procedure for primary hemostasis and preventing recurrent bleeding 4.
Importance of Endoscopic Methods
The use of endoscopic methods in the treatment of Mallory-Weiss syndrome has been shown to decrease operative activity and death rate 5. Endoscopic treatment should be performed rapidly after the first hematemesis, and patients with active bleeding or signs of recent bleeding at endoscopy require immediate endoscopic treatment for hemostasis 4.
Additional Considerations
The treatment of Mallory-Weiss syndrome should also take into account the patient's clinical status and the presence of concomitant gastrointestinal diseases or alcohol intoxication 6. The use of proton pump inhibitors and antiemetics may be logical in all cases, although their efficacy has not been demonstrated in the literature 4.