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.

Mallory-Weiss syndrome must be differentiated from other diseases that cause esophageal ulcers such as:^[1]

Reflux esophagitis: Ulcerations are usually in distal esophagus, and maybe irregular and multiple, unlike Mallory-Weiss syndrome. Patients have history of heartburn and regurgitation.
Infectious esophagitis: Ulcerations are multiple and usually involve the proximal esophagus.
Medication-induced esophagitis: Ulcerations are usually singular and deep with a history of drug use such as tetracycline.

Mallory-Weiss syndrome must be differentiated from other causes of Upper gastrointestinal bleeding:^[2]^[3]^[4]^[5]


Differential Diagnosis	Similar Features	Differentiating Features

Reflux esophagitis	Ulcerations seen in reflux esophagitis are usually in the distal esophagus also observed in Mallory-Weiss syndrome.	Ulcerations are usually in distal esophagus, and maybe irregular and multiple, patients have history of heartburn, dysphagia and regurgitation that distinguish it from Mallory-Weiss syndrome.
Infectious esophagitis	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	Ulcerations are multiple and usually involve the proximal esophagus that distinguish it from Mallory-Weiss syndrome.
Medication-induced esophagitis	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	Ulcerations are usually singular and deep with a history of drug use such as tetracycline that distinguish it from Mallory-Weiss syndrome.

Diseases	History and Symptoms							Physical Examination				Laboratory Findings			Upper endoscopy
Diseases	Hematemesis	Epigastric pain	Light-headedness	Retching	Heartburn	History of medication	Vomiting	Tachycardia	Skin Pallor	Hypotension	Weak pulse	CBC	Platelets	BUN	Upper endoscopy
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

↑ Sutton FM, Graham DY, Goodgame RW (1994). "Infectious esophagitis". Gastrointest. Endosc. Clin. N. Am. 4 (4): 713–29. PMID 7812643.
↑ Boonpongmanee S, Fleischer DE, Pezzullo JC, Collier K, Mayoral W, Al-Kawas F, Chutkan R, Lewis JH, Tio TL, Benjamin SB (2004). "The frequency of peptic ulcer as a cause of upper-GI bleeding is exaggerated". Gastrointest. Endosc. 59 (7): 788–94. PMID 15173790.
↑ Enestvedt BK, Gralnek IM, Mattek N, Lieberman DA, Eisen G (2008). "An evaluation of endoscopic indications and findings related to nonvariceal upper-GI hemorrhage in a large multicenter consortium". Gastrointest. Endosc. 67 (3): 422–9. doi:10.1016/j.gie.2007.09.024. PMID 18206878.
↑ Balderas V, Bhore R, Lara LF, Spesivtseva J, Rockey DC (2011). "The hematocrit level in upper gastrointestinal hemorrhage: safety of endoscopy and outcomes". Am. J. Med. 124 (10): 970–6. doi:10.1016/j.amjmed.2011.04.032. PMID 21962318.
↑ Wollenman CS, Chason R, Reisch JS, Rockey DC (2014). "Impact of ethnicity in upper gastrointestinal hemorrhage". J. Clin. Gastroenterol. 48 (4): 343–50. doi:10.1097/MCG.0000000000000025. PMC 4157370. PMID 24275716.