Mallory-Weiss Tear Is Not Part of a Recognized Syndrome
A Mallory-Weiss tear is not a syndrome itself but rather a specific mucosal laceration at the gastroesophageal junction that occurs as a consequence of forceful retching or vomiting. 1
Understanding the Terminology
The term "Mallory-Weiss syndrome" is sometimes used in the literature, but this is a misnomer that simply refers to the clinical presentation of a Mallory-Weiss tear with upper gastrointestinal bleeding—it is not a distinct syndrome with multiple associated features. 1 The tear represents an epiphenomenon (a secondary consequence) of the underlying cause of vomiting rather than a primary disease entity. 1
Clinical Context and Associated Conditions
While not part of a syndrome, Mallory-Weiss tears occur in specific clinical contexts:
Hiatal hernia is commonly associated with Mallory-Weiss tears, present in the majority of cases. 2
Alcohol ingestion and aspirin use are frequently identified precipitating factors. 2
Cyclic vomiting syndrome: In patients with this condition, Mallory-Weiss tears should be recognized as secondary consequences of the repeated vomiting episodes rather than primary causes of symptoms. 1
Metabolic emergencies: In patients with concurrent thyroid storm and diabetic ketoacidosis, Mallory-Weiss tears account for approximately 15% of upper GI bleeding episodes, with the proportion rising in settings of frequent vomiting. 3
Important Clinical Distinction
In 35% of patients with Mallory-Weiss tears, an additional potential bleeding lesion is identified, and approximately half of these are actually bleeding. 4 This means the tear may coexist with other pathology (such as gastric erosions or esophagitis) that may have instigated the initial retching and vomiting. 2
The tear is typically located posteriorly across the gastroesophageal junction, most commonly on the gastric side. 1, 2
Common Pitfall to Avoid
Do not assume that identifying a Mallory-Weiss tear explains all of the patient's symptoms or bleeding—always look for concurrent lesions that may have triggered the vomiting cascade in the first place. 2, 4 The tear is often a marker of another underlying process rather than an isolated finding.