Vomiting blood may be associated with Mallory-Weiss syndrome, which can develop due to prolonged irritation of the esophagus. Alcoholics and bulimics are often affected.
What is Mallory Weiss Syndrome?
According to Healthknowing, medicine speaks of a Mallory-Weiss syndrome when longitudinal tears in the esophagus cause bleeding with blood vomiting ( hematemesis ). This clinical picture can develop after a sudden increase in pressure in the lower area of the esophagus, for example due to vomiting, choking or coughing.
In the worst case, the esophagus can even rupture ( Boerhaave syndrome ). In Mallory-Weiss syndrome, however, the wall of the esophagus does not tear completely and the contents of the esophagus do not get into the chest cavity. It occurs primarily in people who have chronic irritation of the lining of the esophagus for a variety of reasons.
The main cause of Mallory-Weiss syndrome is chronic mucosal damage, often associated with a sudden increase in pressure in the esophagus. This leads to elongated tears in the mucous membrane inside, which can bleed profusely. In those affected, the mucous membrane of the esophagus was usually irritated over a longer period of time, for example through regular alcohol consumption or frequent vomiting, as is the case with bulimia.
Choking, vomiting or coughing can then increase the pressure in the esophagus so much that the mucous membrane ruptures and causes bleeding. More rarely, the cause is seizures or lifting heavy loads. People with reflux disease, in which the mucous membrane is chronically irritated by the backflow of acidic chyme into the esophagus, are also at higher risk. If the mucous membrane is already damaged, it is less able to withstand a sudden increase in pressure and can tear more easily.
Symptoms, Ailments & Signs
A typical symptom that occurs in Mallory-Weiss syndrome is vomiting blood after repeated bloodless vomiting. Affected people are usually already troubled by the nausea and frequent vomiting, and in Mallory-Weiss syndrome there is also the fear that is triggered by the vomiting of blood. The vomiting of blood can be so severe that it weakens the circulatory system.
There is then a drop in blood pressure and a reflex-induced increase in heart activity. In addition to vomiting blood, there is blood in the stool, which is pitch black in color due to decomposition in the intestines. Due to the anemia, there is a general weakening of the body. Many sufferers also suffer from stomach pains due to frequent vomiting.
Diagnosis & course of disease
In order to be able to make an exact diagnosis, the patient is first asked about his complaints and symptoms in the anamnesis. In order to be able to assess exactly whether it is Mallory-Weiss syndrome, a gastroscopy is carried out, in which the condition of the esophageal mucosa is also examined. If the patient states that he had to gag before the bleeding occurred, this is an indication of Mallory-Weiss syndrome.
During the examination of the upper gastrointestinal tract, the esophagus, stomach and duodenum are examined with regard to possible injuries or pathological changes via an inserted endoscope. If sources of bleeding are found during the examination, they can be treated immediately. If the bleeding is left untreated for a long period of time, it can lead to acute circulatory failure.
In the event of a complete rupture of the esophagus (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 lungs. This area also contains the esophagus, heart, and large blood vessels such as the aorta and vena cava.
Due to the Mallory-Weiss syndrome, those affected suffer in many cases from vomiting, which can also contain blood. It is not uncommon for vomiting blood to lead to a panic attack or sweating. This also leads to a weakening of the circulatory system, so that the patients can also lose consciousness in the further course.
Injuries may occur in the event of a fall. Blood pressure is also reduced and the heart has to beat harder to keep the blood flowing. It can also lead to heart failure. It is not uncommon for Mallory-Weiss syndrome to also lead to bloody stools and thus to anemia.
In addition to vomiting, there is relatively often pain in the stomach and thus significant limitations in everyday life and a reduction in quality of life. If left untreated, it can lead to circulatory failure and death of the patient. A blood transfusion is usually necessary to treat Mallory-Weiss syndrome. There are no particular complications.
However, the treatment of the underlying disease is also necessary, so that those affected often have to undergo a psychological examination or withdrawal. Whether this leads to a reduction in life expectancy depends heavily on the causative disease.
When should you go to the doctor?
People who consume alcohol daily for several years or show withdrawal symptoms as soon as they stop drinking need a doctor. You belong to the risk group of Mallory-Weiss syndrome and should be examined. A doctor’s visit is also advisable for people whose BMI is below the recommended guidelines. If self-initiated vomiting occurs over several weeks or months immediately after eating, see a doctor. An eating disorder is another risk for the disease. Basically, a doctor is needed when 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. Vomiting blood is a cause for concern. A doctor should be consulted as soon as possible as this symptom requires immediate action. If blood appears in the stool, a doctor’s visit is also necessary. The emergence of blood indicates an existing irregularity in the organism, which should not cause any further delays. Stomach pain, black-colored faeces, repeated vomiting, internal weakness or nausea are indications of an existing illness. Various medical tests must be carried out so that a diagnosis can be made and a treatment plan can be drawn up.
Treatment & Therapy
The therapy depends very much on the location and nature of the tear, the time and the general condition of the patient and is therefore individually adapted. If there is massive blood loss, the patient’s circulatory system must first be strengthened by intravenous blood transfusion and fluid transfusions. Flushing with liquid can stop the bleeding, if not, adrenaline is injected with the endoscope in a circle around the source of the bleeding at a distance of about 0.5 centimeters.
In addition, the source of the bleeding, often an artery, can be sclerosed endoscopically. If this measure does not help either, an operation is necessary. In addition, there is drug therapy with mucosa-protecting and acid-inhibiting drugs so that the mucous membrane is not further irritated. In order to achieve good chances of recovery, an early operation is important.
If it occurs more than 24 hours after the tear, patients risk dying from serious complications. The chances of recovery depend very much on the patient’s lifestyle after the procedure. If the cause is excessive alcohol consumption, the patient must in future refrain from excessive drinking and stick to taking the medication. If reflux disease is the cause, regular check-ups must be carried out to prevent Mallory-Weiss syndrome.
Outlook & Forecast
The prognosis of Mallory-Weiss syndrome depends on the underlying disease. In most cases, there is an addiction or a chronic illness that leads to the symptoms. This syndrome is therefore primarily a consequence of an existing impairment and less of an independent disease. In many cases, alcohol abuse or an eating disorder is present. Both lead to severe vomiting and thus to irritation of the esophagus.
As soon as the primary disease is successfully treated, the symptoms of the esophagus resolve in most cases. If the disease progresses unfavorably, the tissue damage is irreversible. Chronic pain develops. Without medical care, an increase in health irregularities is therefore to be expected. If the affected person changes their lifestyle and accepts treatment, the administration of medication can significantly alleviate the symptoms.
In rare cases, an operation is performed. Although this is associated with the usual risks, it is often the last alternative to improve general health. Since the tear in the esophagus leads to a high level of blood loss, it is particularly important for the course of the disease that sufficient blood transfusions are given. Otherwise, the prognosis worsens and subsequent disorders appear.
Since excessive alcohol consumption is one of the main causes for the development of this disease, those affected should keep their alcohol consumption moderate or, if necessary, abstain from alcohol altogether. People with bulimia should undergo psychotherapy early on, because the constant vomiting not only attacks the teeth but also the mucous membranes of the esophagus, worsens the general condition and thus promotes Mallory-Weiss syndrome.
People with reflux syndrome should avoid highly acidic foods and eat smaller meals, as large, high-fat meals encourage reflux from the stomach into the esophagus.
In most cases, Mallory-Weiss syndrome is associated with recurring complications and discomfort, all of which usually reduce the sufferer’s quality of life. The disease cannot heal itself, so permanent treatment by a doctor is necessary.
Generally, follow-up care focuses on the sufferer’s severely compromised circulatory system, preventing them from participating in strenuous or physical activity. A healthy lifestyle, which includes avoiding alcohol as much as possible and getting enough exercise, can help to strengthen the body and thus general well-being. A corresponding change in diet is also recommended in order not to unnecessarily irritate the damaged esophagus. If Mallory-Weiss syndrome is not treated, it can also lead to a reduced life expectancy for those affected.
You can do that 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 protect the gastrointestinal tract during the healing phase and, if possible, to eliminate the causes that led to the occurrence of the disease.
Both bulimia and alcohol addiction require medical and therapeutic treatment, and attending a self-help group can be helpful. If there is an underlying reflux disease, all foods that stimulate the production of stomach acid must be avoided as much as possible. These are mainly greasy, spicy 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 put the head of the bed a little higher and eat dinner at least three hours before bedtime. If heartburn nevertheless occurs, soaked oat flakes, rusks or healing earth dissolved in water relieve itthe complaints. 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 production 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 in peace and without hectic.