Characterization of the syndrome of UGI bleeding from a Mallory-Weiss tear associated with transesophageal echocardiography.

Aim: To quantitatively describe the syndrome of Mallory-Weiss tears associated (MWa) with antecedent transesophageal echocardiography (TEE) as a distinct syndrome.

Methods: Cases of MWa were identified by comprehensive, computerized literature search via PubMed and review of textbooks and monographs on TEE and gastroenterology. Statistical comparison of 17 identified MWa cases versus previously published series of 73 cases of Mallory-Weiss tears unassociated with TEE (MWu) was performed. A new illustrative case is also currently reported.

Results: Comparison between these two groups revealed the following: MWa patients were significantly older (67.1 vs. 52.6 years, p = .0002, assuming equal variance), likely due to MWa patients having preexisting cardiovascular disease for which the TEE was indicated. The two groups had similar sex distributions (60 vs. 76% male, p = .32). MWa patients were significantly, more frequently anticoagulated at the time of bleeding (90.9 vs. 9.6%, p < .00001, OR = 94.3, 95%-OR CI: 9.56-2293), likely because of anticoagulation for underlying cardiac disease for which TEE was indicated. MWa patients tended to more frequently rebleed and more frequently require endoscopic therapy (both parameters: 4/17 vs. 8/73, p = .23) and tended to more frequently require surgery or angiography to control bleeding (3/17 vs. 3/73, p = .08). MWa patients had significantly higher mortality (23.5 vs. 2.7%, p = .01, OR = 10.9, 95%-OR CI 1.48-97.8), likely because of their older age, concomitant heart disease, and administered anticoagulation. A new case of MWa is reported with notable features that extend the clinical spectrum of this syndrome: (1) tear associated with hiatal hernia, (2) presentation with severe, fatal UGI bleeding, and (3) no anticoagulation during bleeding episode.

Conclusions: Patients with MWa represent a distinct clinical subset from patients with MWu, with significantly older mean age, more frequent concomitant anticoagulation, and higher mortality. They also tend to have more severe bleeding. These characteristics are important in clinically managing this syndrome.