Document Detail


Clinical and endoscopic risk factors in the Mallory-Weiss syndrome.
MedLine Citation:
PMID:  9149189     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Although patients with bleeding Mallory-Weiss tears are generally hospitalized, we wished to develop guidelines facilitating the selection, by clinical and endoscopic criteria, of patients who do not need hospitalization. Our specific aims were to determine whether presenting manifestations of bleeding differed in hemodynamically unstable patients, whether active bleeding or stigmata of bleeding at endoscopy were prognosticators for significant rebleeding, and the outcomes in endoscopically managed patients. METHODS: The endoscopic and clinical features of all patients with acute GI bleeding from a Mallory-Weiss tear were obtained from our GI Bleeding Team database over a consecutive 4-yr period and analyzed for prognostic indicators. RESULTS: 1) Presenting manifestations, e.g., hematochezia, were significantly different in hypotensive patients. 2) Active bleeding but not stigmata was associated with higher transfusion requirements. 3) Rebleeding was unusual, occurring within 24 h, more often in patients with a bleeding/coagulation diathesis. The median hospital stay was 4 days (range 1-24). Fifty-seven percent of patients received transfusion (median 4 units, range 1-26 units); requirements were higher in patients with coagulopathies. CONCLUSIONS: Patients without risk factors for rebleeding (portal hypertension, coagulopathy), clinical features indicating severe bleeding (hematochezia, hemodynamic instability), or active bleeding at endoscopy can be managed with a brief period of observation. Patients with endoscopically active bleeding may benefit from endoscopic therapy.
Authors:
A E Bharucha; C J Gostout; R K Balm
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  92     ISSN:  0002-9270     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  1997 May 
Date Detail:
Created Date:  1997-05-28     Completed Date:  1997-05-28     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  805-8     Citation Subset:  IM    
Affiliation:
Division of Gastroenterology and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Endoscopy, Digestive System
Female
Gastrointestinal Hemorrhage / etiology,  therapy
Humans
Male
Mallory-Weiss Syndrome / complications*,  etiology*,  pathology,  therapy
Middle Aged
Predictive Value of Tests
Risk Factors

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