Distinctive aspects of peptic ulcer disease, Dieulafoy's lesion, and Mallory-Weiss syndrome in patients with advanced alcoholic liver disease or cirrhosis

Table 5 Summary of clinical features of acute gastrointestinal bleeding from Mallory-Weiss syndrome in patients with underlying liver disease

Key findings	Ref.
Findings generally associated with Mallory-Weiss syndrome
Characterized by longitudinally oriented mucosal lacerations in the distal esophagus or very proximal stomach	Knauer[101]
Accounts for about 5% of acute upper GI bleeding	Michel et al[100]
Mortality of bleeding from Mallory-Weiss syndrome is only about 3%-5%. Risk factors for mortality include age > 65 yr and significant comorbidities	Ljubičić et al[105]
Findings associated with Mallory-Weiss syndrome associated with alcoholism
MWS strongly associated with alcoholism	Knauer[101]
MWS very frequently (40%-80%) associated with alcoholism or recent binge drinking	Watts et al[106]
Overall prevalence of bleeding from MWS in cirrhosis is up to 10%	del Olmo et al[38], Feng et al[82]
Alcoholics with portal hypertension have higher prevalence of bleeding from MWS (up to 16%)	Paquet et al[26], Schuman et al[27]
MWS may be the first bleeding episode in > 1/3 (37%) of these patients
Patients with cirrhosis have more severe bleeding from MWS and more likely to rebleed from MWS (compared to non-cirrhotics)	Schuman et al[27], Jensen et al[28], Kim et al[107]
Re-bleeding risk particularly high in alcoholics
Contradictory data on effect of portal hypertension on severity of bleeding from MWS	Schuman et al[27], Jensen et al[28]
Bleeding from MWS can precipitate liver failure with its attendant mortality in about 3% of patients with alcoholic cirrhosis	del Olmo et al[38]

GI: Gastrointestinal; MWS: Mallory-Weiss syndrome.