Mallory-Weiss tear: predisposing factors and predictors of a complicated course.
OBJECTIVE
Little has been published regarding predictors of a complicated course after Mallory-Weiss tear (MWT). The aims of this study were to identify risk factors for a Mallory-Weiss tear and factors predictive of a complicated course.


METHODS
At our university hospital, we searched a computerized endoscopy database. At our Veterans Affairs hospital we manually searched printed endoscopy reports. 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 Hct, hypotension or orthostatic changes, and coagulopathy. A complicated course was defined on the basis of >6 U of blood transfused, rebleeding, angiography, surgery, or death. Predictors of a complicated course were evaluated using the Mann-Whitney U test or Fisher exact test.


RESULTS
A total of 73 cases were reviewed. The most common risk factor was alcohol use, which was found in 44% of cases. In all, 23% of patients had no risk factors. Of the patients, 17 (23%) had a complicated course. Patients with a complicated course had a lower admission Hct (p = 0.009) and active bleeding at initial endoscopy (p = 0.013).


CONCLUSIONS
The predictive value of active bleeding supports early endoscopy for stratification and intervention.
Kortas
D Y
DY
Division of Digestive Diseases and Nutrition, University of Kentucky Medical Center, Lexington, USA.
Haas
L S
LS
Simpson
W G
WG
Nickl
N J
NJ
Gates
L K
LK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008309:Mallory-Weiss Syndrome / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D008875:Middle Aged; D012307:Risk Factors