Mallory-Weiss syndrome differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamed Diab, MD [2]

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Overview

Mallory-Weiss syndrome must be differentiated from other causes of Upper gastrointestinal bleeding such as PUD, Esophagogastric varices, Severe or erosive gastritis/duodenitis, Angiodysplasia.

Differential Diagnosis

Mallory-Weiss syndrome must be differentiated from other diseases that cause esophageal ulcers such as:

Diseases	History and Symptoms								Physical Examination				Laboratory Findings			Upper endoscopy
	Hematemesis	Epigastric pain	Light-headedness	Retching	Heartburn	History of medication	Vomiting	History of alcoholism	Tachycardia	Skin Pallor	Hypotension	Weak pulse	CBC	Platelets	BUN
Mallory-Weiss syndrome	+	+	+ (with heavy bleeding)	+	-	-	+	+	+ (with heavy bleeding)	+ (with heavy bleeding)	+ (with heavy bleeding)	+ (with heavy bleeding)	<math>\downarrow</math>	<math>\downarrow</math>	<math>\uparrow</math>	Tears are usually single and located in the esophagogastric junction, usually extends into the cardia and sometimes into the esophagus
Infectious esophagitis	-	+	-	-	-	-	-	-	-	-	-	-				Ulcerations are multiple and usually involve the proximal esophagus
Medication-induced esophagitis	-	+	-	-	-	+	-	-	-	-	-	-				Ulcerations are usually singular and deep
Reflux esophagitis	-	+	-	-	+	-	-	-	-	-	-	-				Ulcerations are usually in distal esophagus, and maybe irregular and multiple

Mallory-Weiss syndrome must be differentiated from other causes of Upper gastrointestinal bleeding:

•  PUD
• Esophagogastric varices
• Severe or erosive gastritis/duodenitis
• Angiodysplasia

Preferred Table

Diseases	History and Symptoms								Physical Examination				Laboratory Findings			Upper endoscopy
	Hematemesis	Epigastric pain	Retching	History of alcoholism	Light-headedness	history of cirrhosis	NSAIDs use	Helicobacter pylori infection	Tachycardia	Hypotension	Skin Pallor	Weak pulse	CBC	Platelets	BUN
Mallory-Weiss syndrome	+	+	+	+	+				+ (with heavy bleeding)	+ (with heavy bleeding)	+ (with heavy bleeding)	+ (with heavy bleeding)	<math>\downarrow</math>	<math>\downarrow</math>	<math>\uparrow</math>	Tears are usually single and located in the esophagogastric junction, usually extends into the cardia and sometimes into the esophagus
PUD	+	+					+	+	+ (with heavy bleeding)	+ (with heavy bleeding)	+ (with heavy bleeding)	+ (with heavy bleeding)	<math>\downarrow</math>	<math>\downarrow</math>	<math>\uparrow</math>	Discrete mucosal lesions with a punched-out smooth ulcer base with whitish fibrinoid base
Esophagogastric varices	+	+		+/-	+	+			+ (with heavy bleeding)	+ (with heavy bleeding)	+ (with heavy bleeding)	+ (with heavy bleeding)	<math>\downarrow</math>	<math>\downarrow</math>	<math>\uparrow</math>	The varices may be in the esophagus and/or the stomach.
Severe or erosive gastritis/duodenitis	+	+							+ (with heavy bleeding)	+ (with heavy bleeding)	+ (with heavy bleeding)	+ (with heavy bleeding)	<math>\downarrow</math>	<math>\downarrow</math>	<math>\uparrow</math>	Erythema, mucosal erosions, the absence of rugal folds, and visible vessels
Angiodysplasia	+	+							+ (with heavy bleeding)	+ (with heavy bleeding)	+ (with heavy bleeding)	+ (with heavy bleeding)	<math>\downarrow</math>	<math>\downarrow</math>	<math>\uparrow</math>	small, flat, cherry-red lesions with a fern-like pattern

References

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