IngentaConnect Mallory-Weiss tear: predisposing factors and predictors of a comp...

Authors: Kortas, D.Y.; Haas, L.S.; Simpson, W.G.; Nickl, N.J.; Gates, L.K.¹

Source: The American Journal of Gastroenterology, Volume 96, Number 10, 1 October 2001 , pp. 2863-2865(3)

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.

Document Type: Research article

DOI: 10.1016/S0002-9270(01)02801-5

Affiliations: 1: aDivision of Digestive Diseases and Nutrition, University of Kentucky Medical Center and Department of Veterans Affairs Medical Center, , Lexington, Kentucky, USA

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