Mallory-Weiss syndrome
ICD-10 K22.6 · ICD-11 DA26.3

Mallory-Weiss Syndrome: When Initial Resuscitation and Medical Therapy Fail to Achieve Hemostasis

In Mallory-Weiss syndrome, the first clinical step is hemodynamic stabilisation combined with pharmacologic therapy. When that approach does not achieve hemostasis — bleeding persists or recurs — a defined next-line protocol applies.

Previous Line — Failure Condition

The first-line protocol encompassed immediate hemodynamic resuscitation following ABC principles, establishment of IV access with fluid resuscitation, packed red blood cell transfusion when indicated, nasogastric decompression, correction of electrolyte imbalances, optimisation of coagulation factors, proton pump inhibitors or H2 receptor antagonists, and antiemetic agents. This line did not reach its primary goals: hemostasis achieved and resolution of symptoms.

Next-Line Approach — Partial Overview

The next step centres on a direct endoscopic evaluation and intervention targeting the bleeding site. Multiple localised interventional modalities may be applied depending on the clinical picture — the full protocol specifies when and how each is used.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.30574/gscarr.2025.23.3.0177

Esophagogastroduodenoscopy (EGD) is the preferred procedure in all UGIB cases.

In cases of ongoing or recurrent bleeding, various endoscopic modalities are available.

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