Epidemiology

Admission to hospital for non-variceal upper gastrointestinal (GI) bleeding is common, with an incidence of about 50 to 150 per 100,000 people per year. Mortality ranges from 8% to 14%.[8] MWT accounts for 5% to 15% of patients with upper GI bleeding.[1] It is less common in children, representing about 0.3% of upper GI bleeds.[9] MWT is more common in men than in women in a ratio of 3:1.[10] In women of childbearing age, the most common cause is hyperemesis gravidarum.[11] MWT has no racial predilection. The age of presentation may vary but is most common in people aged between 30 and 50 years.[9] Recurrent bleeding after an episode of MWT is common.[12][13]

Risk factors

strongVIEW ALL

condition predisposing to retching, vomiting, and/or straining

Conditions that may induce vomiting include food poisoning, gastroenteritis, or any gastrointestinal condition resulting in obstruction; hepatitis, gallstones, and cholecystitis; hyperemesis gravidarum; urinary tract infection, renal failure, and ureteropelvic obstruction; brain tumours, hydrocephalus, congenital disease, trauma, meningitis, pseudotumour cerebri, migraine headaches, and seizures; anorexia nervosa, bulimia, and cyclic vomiting syndrome; toxins, polyethylene glycol lavage, chemotherapy agents, and post-anaesthesia or post-surgery.[11][16][17][18][19][20][21]

chronic cough

May be associated with whooping cough, bronchitis, bronchiectasis, emphysema, COPD, or lung cancer.[22]

hiatal hernia

Hiatal hernia is considered by many to be a precipitating factor.[6][14][15]

endoscopy or other instrumentation

Mucosal tear or laceration during a routine endoscopy is a rare event (0.0001% to 0.4% of people undergoing endoscopy).[23][24] However, it is considered to be the most common cause of iatrogenic tear or laceration.

Other procedures involving instrumentation that may be associated with oesophageal tear or laceration include naso- or orogastric tube placement, endoscope band ligation, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasound.[25]

[Figure caption and citation for the preceding image starts]: 56-year-old female had a gastroscopy for upper GI bleeding 5 days prior treated with a single clip. She continued having melaena and low Hb for the following 5 days after initial procedure. A second gastroscopy detected a longitudinal gastric laceration without perforation on the corpus to cardiaFrom the collection of Juan Carlos Munoz, MD, University of Florida [Citation ends].56-year-old female had a gastroscopy for upper GI bleeding 5 days prior treated with a single clip. She continued having melaena and low Hb for the following 5 days after initial procedure. A second gastroscopy detected a longitudinal gastric laceration without perforation on the corpus to cardia

heavy alcohol use

History of significant alcohol use and vomiting is common in patients who present with MWT. Alcohol use is present in 30% to 60% of patients.[1]

weakVIEW ALL

age 30 to 50 years

Most patients are between the ages of 30 and 50 years, although MWT has been reported in infants aged as young as 3 weeks, as well as in older people.[9][23][26]

male sex

More common in men than in women in a ratio of 3:1.[10]

hiccups

Hiccups have been associated with MWT.[27][28]

blunt abdominal trauma

A sudden increase of intraluminal pressure against a closed glottis has been suggested as the main mechanism for development of MWT, although the pathogenesis is uncertain.[29] Blunt abdominal trauma is one of the mechanisms by which intraluminal pressure can increase.

cardiopulmonary resuscitation

Exact pathogenesis is uncertain, although compression of the oesophagus between the sternum and the vertebrae is probably the most likely explanation.[30]

Use of this content is subject to our disclaimer