Mallory Weiss vs Boerhaave Syndrome – Symptoms, Treatment, Differences

This article reveals the differences between Mallory Weiss syndrome and Boerhaave syndrome.

Mallory Weiss Syndrome (MWS)

Mallory-Weiss syndrome, also referred to as Mallory-Weiss tear, is the medical name given to bleeding and other symptoms which are caused by a tear in the lining of the upper part of the gastrointestinal tract.

In severe cases, it can lead to substantial loss of blood volume.

MWS was initially described in alcoholics (40-80% of patients with MWT have a history of heavy alcohol use), however, it can occur in anyone who vomits forcefully. The ages of people affected vary notably, with a peak at ages 40 to 60.

The syndrome makes up approximately 5 percent of sufferers presenting with upper gastrointestinal bleeding.

Symptoms

Common symptoms include:

  • pale skin;
  • blood in your bowel movements or vomit;
  • feeling dizzy, weak, or faint;
  • shortness of breath;
  • pain in your back or upper abdomen;
  • dark, tarry bowel movements;
  • material which looks like coffee grounds in your vomit.

Complications

Complications may include:

  • metabolic disturbance;
  • vasopressin infusion-related abdominal pain;
  • gastric ischemia;
  • esophageal perforation;
  • hypovolemic shock/death;
  • epinephrine-related ventricular tachycardia;
  • epinephrine-related hypertensive emergency;
  • myocardial ischemia or infarction.

Causes

It is most commonly caused by forceful or long-term vomiting. Other causes can include:

  • convulsions;
  • trauma to the chest or abdomen;
  • hiatal hernia – occurs when part of the stomach bulges into the chest;
  • gastritis – an inflammation of the lining of the stomach;
  • heavy straining or lifting;
  • intense coughing;
  • severe or prolonged hiccups.

Risk Factors

The syndrome is more likely to occur in an individual with one or more of the following risk factors:

  • retching during an endoscopy;
  • hiatal hernia;
  • raised intracranial pressure;
  • excessive alcohol consumption;
  • hyperemesis gravidarum (severe morning sickness);
  • strong emetics (agents which cause vomiting), that are used in some traditional systems of medicine;
  • the intake of medications which may affect blood clotting, such as warfarin and aspirin;
  • blood clotting disorder;
  • gastroenteritis (stomach flu);
  • eating disorders;
  • gastric outlet obstruction;
  • cyclical vomiting syndrome;
  • intestinal obstruction;
  • kidney failure;
  • biliary disease;
  • hepatitis (an inflammatory condition of the liver);
  • esophagitis.

Diagnosis

It is commonly diagnosed by having a test called endoscopy, which involves a long, flexible tube being passed down through the gullet into the stomach.

Treatments

The bleeding which results from tears in the esophagus will stop on its own in approximately 9 out of 10 patients.

Severe bleeding occurs in around 10 percent of suferrers, who need medical intervention, like:

  • therapeutic embolization into the left gastric artery during angiography;
  • intra-arterial infusion of vasopressin;
  • endoscopic hemostasis (by clip placement, injection of epinephrine or ethanol, or by electrocautery).

In rare cases, surgery may be required to treat these tears.

Prevention

Limiting alcohol intake may help prevent the disorder since MWS is linked with alcoholism.

Prognosis

In 90 percent of people whose bleeding does not stop on its own, cauterization without surgery will usually stop the bleeding.

Note – individuals with portal hypertension (an increase in the blood pressure within a system of veins) are at highest risk for a recurrence of bleeding.

Boerhaave Syndrome (BS)

Boerhaave’s syndrome, also referred to as spontaneous esophageal rupture, is the transmural rupture of the esophagus following an increased intrathoracic pressure or an episode of forceful vomiting.

It is a very uncommon, life-threatening surgical emergency and should be suspected in all sufferers presenting with a combination of respiratory and gastrointestinal symptoms and a lower thoracic-epigastric pain.

BS was originally described in 1724 by a Professor of Medicine at Leiden University, named Hermann Boerhaave.

Statistics

The syndrome tends to be more prevalent in males (with a ratio of approximately 2:1), with alcoholism being a high-risk factor. The estimated incidence is about 1:6000. Mortality rates have been reported up to 40 percent even after appropriate surgical intervention and exceed 90 percent if untreated.

Symptomss

Common symptoms may include:

  • air beneath the skin;
  • swallowing difficulties;
  • stiffness or pain in the neck;
  • difficulty breathing;
  • rapid heart rate;
  • low blood pressure;
  • fast breathing;
  • fever;
  • chest pain.

Complications

Possible complications can include:

  • infection around or in the lungs;
  • formation of abscess around and in the esophagus;
  • destruction of the esophagus which is lasting.

Causes

The syndrome usually occurs as a result of a sudden increase in the internal esophageal pressure. Other causes may include:

  • ingestion of poisonous chemicals;
  • an injury caused due to intraluminal pressure;
  • severe vomiting;
  • surgery.

Risk Factors

Risk factors for this syndrome may include:

  • iatrogenic procedures;
  • violent vomiting or retching induced by heavy alcohol consumption;
  • force-feeding;
  • swallowed coins or pills;
  • forceful swallowing;
  • intraoperative perforations, which occur during medical surgeries;
  • penetrating wounds from gunshot or knife stabbing;
  • intake of caustic toxins.

Diagnosis

The diagnosis of BH is confirmed by contrast computed tomography of the chest or contrast esophagram (during this test, x-ray pictures of the esophagus are taken after a person drinks a liquid which contains barium sulfate).

Note – the diagnosis may be missed or difficult when a sufferer presents with chronic symptoms which mimic other health issues.

Treatment

Treatment involves mixing a conservative and a surgical approach and includes:

  • a surgical intervention which is prompt;
  • draining any fluid which collects around the lung using a chest tube;
  • administering fluids through IV;
  • administering IV broad-spectrum antibiotics.

Bottom Line – Mallory Weiss vs Boerhaave Syndrome

Mallory-Weiss syndrome is a tear in the tissue where the stomach and esophagus meet. The tear is prone to bleeding and accounts for about 5 percent of upper gastrointestinal hemorrhage. The hemorrhage is typically self-limited, ceasing spontaneously in approximately 90 percent of suferrers. About fifty percent of the patients experience for the first time this upper gastrointestinal bleeding.

Boerhaave’s syndrome is a rare, well-defined syndrome which is caused by a longitudinal perforation of the esophagus. BS can be morbid if not treated appropriately and on time.

In conclusion, BS is a transmural perforation of the esophagus, that distinguishes itself from MWS, that is a nontransmural esophageal tear with similar signs and symptoms.

References

https://www.ncbi.nlm.nih.gov/pubmed/10778523
https://www.ncbi.nlm.nih.gov/pubmed/6600377
https://www.sciencedirect.com/science/article/pii/0002961083901629