A Mallory Weiss tear (MWT) or Mallory Weiss Syndrome (MWS) is a tear in the lower half of the esophagus. It results from an injury to the esophagus and can cause a person to cough up blood due to upper gastrointestinal (GI) bleeding.

MWS is one of the most common causes of upper gastrointestinal (GI) bleeding. People with this condition may notice blood in their saliva or mucus. They may also cough up or vomit blood.

The tear typically occurs between the esophagus and stomach but can also extend upward.

Most cases of MWS involve mild GI bleeding and typically clear up on their own. However, some people may experience severe bleeding and require emergency treatment.

This article describes what MWS is, including its symptoms, causes, diagnosis, and treatment. We also provide information on the outlook for people with MWS.

A nurse in scrubs talking to a person with a Mallory Weiss tear.Share on Pinterest
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An MWT or MWS is a tear in the lower half of the esophagus. The tear usually occurs at the gastroesophageal junction, where the esophagus meets the stomach.

The main symptom of MWS is upper GI bleeding, which may present as:

Around 90% of MWS cases are self-limiting, meaning the condition goes away with or without treatment, usually within 72 hours.

However, significant GI bleeding increases the risk of complications, including shock. This is where the body’s organs and tissues do not function properly due to insufficient blood flow. The condition can result in death.

Mallory Weiss tear vs. Boerhaave syndrome

While MWS refers to a tear in the esophagus, Boerhaave syndrome (BS) refers to a hole that goes all the way through the esophagus.

Both conditions have similar risk factors and symptoms, such as retching and severe vomiting. However, MWS often resolves with conservative treatment, whereas BS is a life threatening emergency requiring prompt medical treatment. Even with medical care, the survival rate for BS is only 75%.

MWS can be serious, as around 10% of people with this condition develop shock. Individuals with significant blood loss are more likely to develop serious complications and require emergency treatment.

Significant blood loss also increases the risk of death. A 2022 study reports that around 5.7% of people with MWS die within 30 days of receiving a diagnosis.

However, the prognosis for most individuals with MWS is positive. In around 90% of cases, symptoms resolve following conservative management.

A mild case of MWS may not cause any symptoms, though most people will cough up or vomit blood. Some may also experience stomach pain.

In more severe cases, a person may experience additional symptoms, such as:

MWS occurs due to injury to the esophagus, which can stem from:

  • a chronic cough
  • vomiting, straining, or retching, especially forcefully
  • trauma to the esophagus
  • endoscopic surgery on the esophagus

Some medical conditions that can increase the risk of the condition include:

  • esophageal varices, which refer to large or swollen blood vessels around the esophagus
  • hiatal hernia, when internal tissue or part of an organ pushes through a weakness in the wall of the food pipe
  • portal hypertension, an increase in blood pressure inside the portal vein

Between 50% and 70% of people who receive a diagnosis of MWS have a history of heavy alcohol consumption. One of the most significant risk factors for the condition is the combination of drinking alcohol and vomiting.

When diagnosing MWS, a doctor may ask about a person’s alcohol consumption and recent medical history.

A doctor may also order blood and urine tests and take a person’s blood pressure to test for signs of shock.

An endoscopy may be necessary to help diagnose or rule out MWS. This procedure involves inserting a thin, flexible tube called an endoscope into the esophagus via the mouth. The endoscope holds a camera, which allows the surgeon to view the esophagus for signs of damage.

MWS does not always require treatment. In many cases, the condition resolves on its own. However, the condition can be serious, so medical monitoring is important to reduce the risk of complications.

It is important to note that the symptoms of MWS can mimic those of other conditions. As such, any person who experiences signs and symptoms of GI bleeding should consult a doctor to determine the cause.

Some treatment options for MWS include:

  • Medication: A person may require one or more of the following medications:
    • fluids and electrolytes to help stabilize blood pressure and metabolic processes
    • medications to constrict the blood vessels and reduce bleeding
    • proton pump inhibitors and H2 blockers to decrease stomach acid, thereby helping the esophagus heal
  • Blood transfusion: A blood transfusion may be necessary for a person who experiences excessive blood loss due to severe GI bleeding.
  • Endoscopic therapy: A doctor can often treat an esophageal tear during an endoscopic procedure. This may involve injecting epinephrine into the tear to stop the bleeding.
  • Surgery: If endoscopic procedures and other interventions do not stop the bleeding, surgery may be necessary to stitch the tear.

During recovery, a doctor may recommend dietary changes, such as reducing or eliminating alcohol.

The outlook for a person with MWS primarily depends on the amount of blood loss. However, more bleeding has links to a more negative prognosis. Complications people may experience as a result of excessive blood loss include:

  • metabolic disturbances
  • shock
  • heart attack
  • death, if the bleeding does not stop

For most people, the outlook is positive and the GI bleeding does not recur.

A 2022 study notes that the following factors predict worsened bleeding and more negative outcomes for people with MWS:

  • older age
  • very low hemoglobin
  • tarry stools
  • active bleeding during endoscopy
  • shock

A 2022 study of 125 people with MWS bleeding found that 5.7% of people died within 30 days of receiving a diagnosis of MWS.

A Mallory Weiss tear or MWS is a tear in the lower half of the esophagus, typically at the intersection between the esophagus and stomach. This may cause symptoms, such as noticing blood in the saliva or mucus or coughing or vomiting blood.

Most cases of MWS resolve within a few days with or without medical treatment. However, a person who experiences symptoms of MWS should seek urgent medical attention. This is because severe tears can cause major blood loss and associated complications, including death.