Chapter 39- UGI Bleed- MW Syndrome

Question 1

What is it?

Answer 1

Postretching, postemesis longitudinal tear (submucosa and mucosa) of the stomach near the GE junction; approximately three fourths are in the stomach

Question 2

For what percentage of all UGI bleeds does this syndrome account?

Answer 2

≈10%

Question 3

What are the causes of a tear?

Answer 3

Increased gastric pressure, often aggravated by hiatal hernia

Question 4

What are the risk factors?

Answer 4

1. Retching
2. alcoholism (50%)
3. >50% of patients have hiatal hernia

Question 5

What are the symptoms?

Answer 5

1. Epigastric pain
2. thoracic substernal pain
3. emesis
4. hematemesis

Question 6

What percentage of patients will have hematemesis?

Answer 6

85%

Question 7

How is the diagnosis made?

Answer 7

EGD

Question 8

What is the “classic” history?

Answer 8

Alcoholic patient after binge drinking—first, vomit food and gastric contents, followed by forceful retching and bloody vomitus

Question 9

What is the treatment?

Answer 9

• Room temperature water lavage (90% of patients stop bleeding)
• electrocautery
• arterial embolization
• surgery for refractory bleeding

Question 10

When is surgery indicated?

Answer 10

When medical/endoscopic treatment fails