Researchers from the University of Kentucky Medical Center, Lexington, USA, identified the risk factors for a Mallory-Weiss tear (MWT) and factors predictive of a complicated course.
A computerized endoscopy database was searched at the authors' university hospital. In addition, printed endoscopy reports were manually searched at the authors' Veterans Affairs hospital.
Proposed risk factors for MWT were: history of alcohol use, recent alcohol binge, nonbloody initial emesis, anticoagulation, other coagulopathy, nonsteroidal anti-inflammatory use, and hiatal hernia.
Proposed predictors of a complicated course were: age, hematemesis, melena, hematochezia, visible vessel, adherent clot, active bleeding, multiple tears, other pathology at endoscopy, admission hematocrit, hypotension or orthostatic changes, and coagulopathy.
A complicated course was defined on the basis of more than 6 units of blood transfused, rebleeding, angiography, surgery, or death.
| Alcohol use was the most common risk factor for a Mallory-Weiss tear.
| American Journal of Gastroenterology |
A total of 73 cases were reviewed.
The researchers found that the most common risk factor was alcohol use, which was found in 44% of cases.
In all, 23% of patients were found to have no risk factors.
Of the patients, 17 (23%) had a complicated course. Patients with a complicated course had a lower admission hematocrit and active bleeding at initial endoscopy.
Author D. Y. Kortas concluded on behalf of the team, "The predictive value of active bleeding supports early endoscopy for stratification and intervention."