42-year-old presenting with acute heatemesis

alcohol use disorder

Key Point:

Mallory-Weiss tears are acute lacerations of the distal esophageal mucosa caused by severe vomiting and retching. Alcohol use disorder is the most common cause.

Explanation:

The patient has Mallory-Weiss tears. These are acute lacerations of the distal esophageal mucosa as a consequence of retching and severe vomiting.  A history of alcohol use disorder is very common as a trigger.

Hyperemesis gravidarum can cause Mallory-Weiss tears during pregnancy, but gastrointestinal symptoms usually resolve after delivery.

Bulimia can be associated with forced vomiting and may also cause Mallory-Weiss lesions (rather than anorexia).

Liver cirrhosis can be associated with esophageal varices rather than Mallory-Weiss tears.

References:

Biecker E. Diagnosis and therapy of non-variceal upper gastrointestinal bleeding. World J Gastrointest Pharmacol Ther. 2015;6(4):172-182.

Tjwa ET, Holster IL, Kuipers EJ. Endoscopic management of nonvariceal, nonulcer upper gastrointestinal bleeding. Gastroenterol Clin North Am. 2014;43(4):707-719.