Vomiting blood may be associated with Mallory-Weiss syndrome, which can develop because of long-term irritation of the esophagus. It often affects alcoholics and bulimics.
What is Mallory-Weiss syndrome?
Medical science refers to Mallory-Weiss syndrome when longitudinal tears in the esophagus cause bleeding with vomiting of blood (hematemesis). This clinical picture can develop after an abrupt increase in pressure in the lower part of the esophagus, for example, due to vomiting, retching, or coughing. In the worst case, the esophagus may even rupture (Boerhaave syndrome). In Mallory-Weiss syndrome, however, the esophageal wall does not tear completely and the contents of the esophagus do not enter the chest cavity. It occurs predominantly in people in whom the mucosa of the esophagus is chronically irritated for various reasons.
Causes
The main cause of Mallory-Weiss syndrome is chronic mucosal damage, often associated with a sudden increase in pressure in the esophagus. This results in elongated mucosal tears inside, which can bleed profusely. In affected individuals, the mucosa of the esophagus has usually been irritated over a long period of time, for example by regular alcohol consumption or frequent vomiting, as is the case with bulimia. Choking, vomiting or coughing can then increase the pressure in the esophagus to such an extent that the mucosa tears and causes bleeding. Less commonly, the cause is seizures or lifting heavy loads. People with reflux disease, in which the mucosa is chronically irritated by the reflux of acidic food pulp into the esophagus, are also at higher risk. If the mucosa is already damaged, it is less able to withstand a sudden increase in pressure and can tear more easily.
Symptoms, complaints, and signs
A typical symptom that occurs in Mallory-Weiss syndrome is vomiting of blood after repeated bloodless vomiting. Affected individuals are usually already bothered by the nausea and frequent vomiting, and Mallory-Weiss syndrome is compounded by the anxiety caused by vomiting blood. The vomiting of blood can be so severe that it weakens the circulation. There is then a drop in blood pressure and a reflex increase in heart activity. In addition to the vomiting blood, there is blood in the stool, which is pitch black in color due to decomposition in the intestines. Due to anemia, there is a general weakening of the body. Many affected individuals additionally suffer from stomach pain due to the frequent vomiting.
Diagnosis and course of the disease
In order to make an accurate diagnosis, the patient is first asked about his complaints and symptoms in the medical history. To accurately assess whether the condition is Mallory-Weiss syndrome, a gastroscopy is performed, which also examines the condition of the esophageal mucosa. If the patient states that he had to gag before the bleeding occurred, this is an indication of Mallory-Weiss syndrome. During the upper gastrointestinal endoscopy, an inserted endoscope is used to examine the esophagus, stomach, and duodenum for possible injury or abnormal changes. If sources of bleeding are found during the examination, they can be treated immediately. If bleeding is left untreated for a prolonged period of time, acute circulatory failure may occur. In the case of a complete esophageal tear (Boerhaave’s syndrome), there is also a risk of fluid accumulating in the pleural space (pleural effusion) or air in the mediastinal space between the two thoracic sacs of the lung. This area also contains the esophagus, heart, and major blood vessels such as the aorta and vena cavae.
Complications
Due to Mallory-Weiss syndrome, in many cases, affected individuals suffer from vomiting, which may include blood. It is not uncommon for vomiting blood to also lead to a panic attack or sweating. This also leads to a weakening of the circulation, so that patients can lose consciousness in the further course. This can possibly lead to injuries in the event of a fall. Blood pressure is also reduced and the heart has to beat harder to maintain the blood flow. This can also result in heart failure. It is not uncommon for Mallory-Weiss syndrome to also lead to bloody stools and thus anemia.In addition to vomiting, pain in the stomach is relatively common, resulting in significant limitations in everyday life and a reduction in quality of life. Without treatment, circulatory failure may occur, resulting in death of the patient. Usually, a blood transfusion is necessary to treat Mallory-Weiss syndrome. This does not lead to any particular complications. Furthermore, however, treatment of the underlying disease is also necessary, so that it is not uncommon for those affected to have to undergo psychological testing or withdrawal. Whether this results in a reduction in life expectancy depends largely on the causative disease.
When should you see a doctor?
People who consume alcohol daily for several years or show withdrawal symptoms as soon as no alcohol is consumed need to see a doctor. They are in the at-risk group for Mallory-Weiss syndrome and should get a checkup. A visit to the doctor is also advisable for people whose BMI is below the recommended guidelines. If self-initiated vomiting occurs immediately after food intake for several weeks or months, a physician should be consulted. An eating disorder poses another risk for the condition. Basically, a doctor is needed if the circulation is weakened. A low level of performance, a drop in blood pressure or an increase in heart rate should be examined and clarified by a doctor. If there is vomiting of blood, there is cause for concern. A physician should be seen as soon as possible, as immediate action is needed for this symptom. If blood appears in the stool, a visit to the doctor is equally necessary. The leakage of blood indicates an existing irregularity of the organism, in which there should be no further delay. Stomach pain, black colored feces, repeated vomiting, an internal weakness or nausea, are indications of an existing disease. The performance of various medical tests is necessary so that a diagnosis can be made and a treatment plan developed.
Treatment and therapy
Therapy is highly dependent on the location and nature of the tear, the timing, and the patient’s general condition, and is therefore individualized. If there is massive blood loss, the patient’s circulation must first be strengthened by intravenous blood transfusion and fluid transfusions. Flushing with fluid may stop the bleeding; if not, epinephrine is injected in a circle around the source of bleeding at a distance of about 0.5 centimeter with the help of the endoscope. In addition, the source of bleeding, often an artery, can be sclerosed endoscopically. If this measure also does not help, surgical intervention is necessary. In addition, drug therapy with mucosa-protecting and acid-inhibiting drugs is given to prevent further irritation of the mucosa. In order to achieve good healing chances, early surgery is important. If it is not performed until more than 24 hours after the rupture, there is a risk that patients will die from serious complications. The chances of recovery are highly dependent on the patient’s lifestyle after surgery. If the cause is excessive alcohol consumption, the patient must refrain from alcohol excesses in the future and adhere to taking medication. If the cause is reflux disease, regular checkups must be performed to prevent Mallory-Weiss syndrome.
Outlook and prognosis
The prognosis of Mallory-Weiss syndrome is tied to the underlying disease present. In most cases, there is an addictive disorder or a chronic disease that leads to the symptoms. Therefore, this syndrome is primarily a consequence of an existing impairment rather than a disease in its own right. In many cases, alcohol abuse or an eating disorder is present. Both lead to severe vomiting and thus irritation of the esophagus. Once the primary disease is successfully treated, in most cases there is a regression of the esophageal symptoms. If the disease progresses unfavorably, the tissue damage is irreversible. Chronic pain develops. Therefore, without medical care, an increase in health irregularities is to be expected.If the affected person changes his lifestyle and accepts treatment, significant relief of the symptoms can be achieved by administering medication. In rare cases, surgery is performed. Although this is associated with the usual risks, it is nevertheless often the last alternative for improving general health. Since there is a high blood loss due to the tear in the esophagus, it is particularly crucial for the course of the disease that sufficient blood transfusions are given. Otherwise, the prognosis worsens and sequelae occur.
Prevention
Because excessive alcohol consumption is one of the main causes of the development of this disorder, affected individuals should be moderate in their alcohol consumption or, if necessary, abstain from alcohol altogether. Bulimia sufferers should undergo psychotherapy at an early stage, because the constant vomiting severely attacks not only the teeth but also the esophageal mucosa, worsens the general condition, and in this way promotes Mallory-Weiss syndrome. People with reflux syndrome should avoid highly acidifying foods and eat smaller meals, as lavish, high-fat meals promote reflux from the stomach into the esophagus.
Follow-up
In most cases, Mallory-Weiss syndrome is associated with recurrent complications and discomfort, all of which usually reduce the sufferer’s quality of life. Self-cure of the disease may not occur in these cases, so permanent treatment by a physician is necessary. In general, follow-up care focuses on the severely weakened circulation of the affected person, so that they can no longer participate in strenuous or physical activities. A healthy lifestyle, which includes largely abstaining from alcohol and sufficient exercise, can help to strengthen the body and thus the general well-being. An appropriate change in diet is also recommended to avoid unnecessary irritation of the damaged esophagus. If Mallory-Weiss syndrome is not treated, it can also lead to a reduced life expectancy of the affected person.
Here’s what you can do yourself
Acute bleeding that occurs as part of Mallory-Weiss syndrome must always be treated by a doctor. After that, it is extremely important to take care of the gastrointestinal tract during the healing phase and, if possible, to stop the causes that led to the occurrence of the disease. Both bulimia and alcohol addiction require medical and therapeutic treatment, and attendance at a self-help group can be helpful. If reflux disease is the underlying cause, all foods that stimulate the production of gastric acid must be avoided as far as possible. These are mainly fatty, strongly spiced and very sugary foods, coffee, alcohol and chocolate. Several small meals spread throughout the day are better tolerated than three large ones. If you suffer from heartburn at night, you should raise the head of your bed a little and eat your evening meal at least three hours before going to bed. If heartburn still occurs, soaked oatmeal, rusks or healing clay dissolved in water will alleviate the discomfort. Chamomile tea and cheese poplar tea have an anti-inflammatory effect and protect the damaged mucous membrane of the esophagus. Aloe vera juice is also a proven home remedy for heartburn. Stress can increase the formation of stomach acid. A conscious deceleration of everyday life, learning relaxation techniques and regular sporting activities promote well-being. Meals in particular should always be taken calmly and without rushing.
