Video Endoscopic Sequence 1 of 2.

Mallory Weiss Tear

This 58 year-old female, 3 days previously had hematemesis.

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Video Endoscopic Sequence 2 of 2.

A Hiatal Hernia is seen with longitudinal tear.

 Hiatal hernia has been found in 40 to 100 percent of
 patients with Mallory-Weiss tears and has been considered
 by some to be a necessary predisposing factor. It has been
 proposed that, in hiatus hernia, a higher pressure gradient
 develops in the hernia compared with that in the rest of the
 stomach during retching, thereby increasing the potential
 for mucosal laceration. Gastroesophageal tears may also
 be more likely to occur when the upper esophageal
 sphincter does not relax during vomiting.

 Mallory-Weiss syndrome is characterized by longitudinal
 mucosal lacerations (intramural dissections) in the distal
 esophagus and proximal stomach, which are usually
 associated with forceful retching. The lacerations often
 lead to bleeding from submucosal arteries. Since the initial
 description in 1929 by Mallory and Weiss in 15 alcoholic
 subjects.

Video Endoscopic Sequence 1 of 3.

 A 68 year-old female, one week previously presented a
 history of severe vomiting, which later had melena.
 
 The endoscopy displayed here is performed one week
 after the inicial symtoms. A Mallory Weiss tear was
 showed, presented as a linear ulcer.
 The Mallory Weiss tear is localized to the gastric side
 side of the squamocolumnar junction or extends across
 the z line into the esophagus.

 The original description by Mallory and Weiss in 1929 involved
 patients with persistent retching and vomiting following an
 alcoholic binge. However, Mallory-Weiss syndrome may occur
 after any event that provokes a sudden rise in intragastric
 pressure or gastric prolapse into the esophagus.
 Pathophysiology: A Mallory-Weiss tear (MWT) likely occurs
 as a result of a large, rapidly occurring, and transient transmural
 pressure gradient across the region of the gastroesophageal
 junction. Acute distension of the nondistensible lower esophagus
 can also produce a linear tear in this region.
 With a rapid rise in intragastric pressure due to precipitating
 factors such as retching or vomiting, the transmural pressure
 gradient increases dramatically across the hiatal hernia, which
 abuts a low intrathoracic pressure zone. If the shearing forces are
 high enough, a longitudinal laceration eventually occurs. Within the
 hernia, the tear is more likely to involve the lesser curvature of the
 gastric cardia, which is relatively immobile compared to the
 remainder of the stomach.
 Another potential mechanism for MWTs is the violent prolapse or
 intussusception of the upper stomach into the esophagus, as can
 be witnessed during forceful retching at endoscopy.
 
 
                                           
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Video Endoscopic Sequence 2 of 3.

 Same case as above, the retroflexed maneuver displays
 a linear ulcer at the gastroesophageal junction.

 The Mallory Weiss tear is an acute lesion that, when
 viewed soon after the tear occurs, has the appearance of
 an edematous and irregular split in the mucosa.  
 Bleeding is usually multifocal, but can arise from an
 exposed intramural artery branching off the left gastric
 artery.

Video Endoscopic Sequence 3 of 3.

 The classic presentation for the Mallory Weiss tear is
 a sequence of events beginning with nausea and
 vomiting followed soon by hematemesis.
   

 
 A 43 year-old man who had been drinking alcoholic
 beverages, after that, he undergone vomiting and bleeding.
 The video clip displays a hiatal hernia, reflux esophagitis
 and a blood clot that covers the mucosal tear.

 A history of heavy alcohol use leading to vomiting has been
 noted in 40 to 80 percent of patients with Mallory-Weiss
 syndrome in most series.The bleeding is usually more
 severe when Mallory-Weiss tears are associated with
 portal hypertension and esophageal varices. Occasionally,
 patients give a history of ingestion of aspirin or
 nonsteroidal antiinflammatory drug.

Mallory Weiss Syndrome.

 34 year-old male physician who had been drinking alcoholic
 beverages and started vomiting, immediately, after that,
 the patient had an upper gastrointestinal bleeding.
 

Video Endoscopic Sequence 1 of 3.

 54 year-old female, who had induced vomiting a day before
 because of a feeling of malaise. Melena was observed.
 Her hemoglobin was 8.1 mg/dl.
 She underwent upper endoscopy, and a gastroesophageal
 tear was found at the gastroesophagic junction.
 

Video Endoscopic Sequence 2 of 3.

 The image and the video display a ulcer with a blood clot
 the endoscope is retroflexed.

Video Endoscopic Sequence 3 of 3.

 The blood clot is observed in retroflexed maneuver.

 How frequently a Mallory-Weiss tear occurs without
 bleeding cannot be determined with any certainty. It is
 highly likely that the condition occurs in a less severe form
 more frequently than is recognized.