Saturday, September 29, 2012

Need another reason not to binge drink? Mallory-Weiss tear

http://www.ncbi.nlm.nih.gov/pubmed/11693318


 2001 Oct;96(10):2863-5.

Mallory-Weiss tear: predisposing factors and predictors of a complicated course.

Source

Division of Digestive Diseases and Nutrition, University of Kentucky Medical Center, Lexington, USA.

Abstract

OBJECTIVES:

Little has been published regarding predictors of a complicated course after Mallory-Weiss tear (MWT). The aims of this study were to identify risk factors for a Mallory-Weiss tear and factors predictive of a complicated course.

METHODS:

At our university hospital, we searched a computerized endoscopy database. At our Veterans Affairs hospital we manually searched printed endoscopy reports. Proposed risk factors for MWT were: history of alcohol use, recent alcohol binge, nonbloody initial emesis, anticoagulation, other coagulopathy, nonsteroidal anti-inflammatory use, and hiatal hernia. Proposed predictors of a complicated course were: age, hematemesis, melena, hematochezia, visible vessel, adherent clot, active bleeding, multiple tears, other pathology at endoscopy, admission Hct, hypotension or orthostatic changes, and coagulopathy. A complicated course was defined on the basis of >6 U of blood transfused, rebleeding, angiography, surgery, or death. Predictors of a complicated course were evaluated using the Mann-Whitney U test or Fisher exact test.

RESULTS:

A total of 73 cases were reviewed. The most common risk factor was alcohol use, which was found in 44% of cases. In all, 23% of patients had no risk factors. Of the patients, 17 (23%) had a complicated course. Patients with a complicated course had a lower admission Hct (p = 0.009) and active bleeding at initial endoscopy (p = 0.013).

CONCLUSION:

The predictive value of active bleeding supports early endoscopy for stratification and intervention.

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