title: Predictive factors of recurrent bleeding in Mallory-Weiss syndrome.
abstract: OBJECTIVE
  Although the majority of patients with Mallory-Weiss syndrome (MWS) have a benign course, MWS patients with recurrent bleeding have an unfavorable outcome and require intensive care. Therefore, this study was carried out to identify the risk factors for recurrent bleeding in MWS patients.
  
  
  METHODS
  The medical records of patients with MWS between January 1999 and December 2003, were reviewed retrospectively. Demographics, initial clinical and laboratory parameters, and endoscopic findings of the patients with and without recurrent bleeding were compared and the potential risk factors predicting recurrent bleeding in MWS were evaluated.
  
  
  RESULTS
  A total of one hundred and fifty-nine patients (22 women, 137 men, mean age 48.1 years old) were enrolled in the study. Recurrent bleeding was observed in 17 patients (10.7%). Those patients with recurrent bleeding showed higher frequency for the presence of shock at initial manifestation, combined liver cirrhosis and endoscopic findings of active bleeding, lower hemoglobin level and platelet count, higher amount of transfusions and epinephrine-mixed fluid injections, and longer hospital stay than those patients without recurrent bleeding. Significant risk factors predicting the recurrent bleeding in MWS were the presence of shock at initial manifestation (OR 3.71, 95% CI 1.07-14.90) and the evidence of active bleeding on endoscopic examination (OR 9.89, 95% CI 1.88-51.98) on multivariate analysis.
  
  
  CONCLUSIONS
  Intensive care with close monitoring is required for the patients with shock on initial manifestation or with evidence of active bleeding on endoscopic examinations since these are independent risk factors predicting the recurrent bleeding in MWS patients.
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Jae Woo
authors.initials: JW
authors.lastname: Kim
authors.forename: Hyun Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Jong Won
authors.initials: JW
authors.lastname: Byun
authors.forename: Chan Sik
authors.initials: CS
authors.lastname: Won
authors.forename: Myeong Gwan
authors.initials: MG
authors.lastname: Jee
authors.forename: Yong Soon
authors.initials: YS
authors.lastname: Park
authors.forename: Soon Koo
authors.initials: SK
authors.lastname: Baik
authors.forename: Sang Ok
authors.initials: SO
authors.lastname: Kwon
authors.forename: Dong Ki
authors.initials: DK
authors.lastname: Lee
mesh_terms: D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008309:Mallory-Weiss Syndrome / Q000150:complications* / Q000473:pathology / Q000628:therapy; D008875:Middle Aged; D012008:Recurrence