Mallory-Weiss syndrome manifesting as upper GI bleed in patients undergoing Hemodialysis: A case report

Shuai-Shuai Shi et al from the Department of Nephrology, Heji Hospital of Changzhi Medical College, Changzhi, China reported Mallory-Weiss syndrome in four patients undergoing Hemodialysis. The case study was published in the journal BMC Nephrology.

Mallory-Weiss syndrome (MWS) is a benign, self-limiting condition that causes gastrointestinal bleeding in hemodialysis patients. It is caused due to the non-transmural lacerations of the esophagogastric junction caused by severe vomiting and other inducements. It is often induced by severe vomiting and manifests as upper gastrointestinal bleeding. Despite the condition having a good prognosis, the early symptoms of hematemesis are often missed, leading to a delay in the diagnosis and complicating the situation.

Researchers from the Department of Nephrology, Heji Hospital of Changzhi Medical College, Changzhi, China reported four patients receiving maintenance hemodialysis with MWS. All patients displayed symptoms of upper gastrointestinal bleeding. The diagnosis of MWS was confirmed by gastroscopy. One patient had a history of severe vomiting whereas the other three reported a history of mild vomiting. Three patients received the conservative hemostasis treatment, and the gastrointestinal bleeding stopped. One patient underwent gastroscopic and interventional hemostasis treatments. The conditions of three of the patients improved. Unfortunately, one of the patients died due to cardiac insufficiency.

Mild cases of MWS can be asymptomatic but most cases of MWS present with hematemesis with a variable quantity of blood. Gastroscopy is used for diagnosing the condition. Any tear of the mucosa, submucosal hematoma, and bleeding are used as the diagnostic criteria. Hemodialysis patients tend to have GI bleeding but the symptoms may sometimes be mild. Certain risk factors like age, uremic toxins, anemia, certain drugs (i.e., nonsteroidal anti-inflammatory drugs), vascular calcification, cardiac insufficiency, related diseases such as diabetes, and various types of vasculitis are predisposing factors for MWS.

Conservative treatment approaches like acid suppression, hemostasis using gastroscopy, and interventional vascular embolization can be used for stabilization. For patients with severe symptoms, gastroscopic hemostasis is the first choice, and interventional hemostasis can also be considered. For patients with mild symptoms, drug hemostasis is the first consideration.

Further reading: Shi, SS., Yang, XZ., Zhang, Xy. et al. Mallory-Weiss syndrome in four hemodialysis patients: a case study. BMC Nephrol 24, 188 (2023). https://doi.org/10.1186/s12882-023-03250-x