Bringing up blood: Esophageal tears need fast repair

Starvin’ like Marvin! Yes, don’t we all feel that from time to time? You know you shouldn’t eat it, but it taunts you. It whispers to you, “C’mon. Eat me. You’re hungry, and I’m delicious. Just eat me!”

Recently I ate some two-day-old baked ziti that had been out of the fridge for a few hours. I was at work late, and I was hungry. I ate maybe a fistful without even heating it up. And an hour later– bleeeeh!

What bad things can happen when you puke?

Well, beside the obvious, a Mallory-Weiss tear can occur. These are actually tears in the lower esophagus and stomach that can result from forceful retching. In 1929, two researchers, Kenneth Mallory and Soma Weiss, described this type of gastrointestinal (GI) bleed seen in 15 alcoholic patients.

So Mallory-Weiss realized that where the stomach and esophagus meet, the area can develop lacerations, allowing the underlying arteries to bleed.

I’m not against alcohol when it’s used responsibly, but heavy drinking causes problems (fights, bad relationships, becoming a Desperate Housewife television star). Forty to 80 percent of Mallory-Weiss tears occur in heavy drinkers.

Blood in the emesis (i.e. vomitus, the puke) is a clue to an upper GI bleed. Usually the blood coming up doesn’t look like a True Blood or Twilight vampire’s mouth after a feast. It tends to be small.

Stomach pain located just south of the breastbone often occurs from Mallory-Weiss tears, but pain can also occur directly in the back. Vomiting and retching (retching means trying to vomit, because for many people, it takes a few heaves to bring things up) precede the bleed because it’s the force and pressure of the process that tear the lining of the esophagus and stomach.

Hiatal hernias are a large risk factor for a Mallory-Weiss tear, probably because of the increased pressure of the esophagus herniating into the chest through the diaphragm.

Besides vomiting, other things can put stress on the esophagus/stomach area of Mallory-Weiss tears: straining while pooping, coughing, lifting heavy objects, convulsions, closed-chest massage— and, get this: hiccups under anesthesia!

If you vomit up blood, you have to go to the emergency room.

Though the tears usually heal on their own, too much blood might be lost before that occurs. Forty to 70 percent of folks with Mallory-Weiss need a blood transfusion. Most vulnerable for prolonged bleeding or re-bleeding are folks on anticoagulants like aspirin and warfarin.

An even worse case of an esophageal bleed is Boerhaave’s syndrome, in which the esophagus is perforated (i.e. blown open). An endoscopy can do this. Boerhaave’s can occur from straining or vomiting due to pressure that fully tears open the esophagus.

So an unhealthy esophagus– from swallowing something caustic (like a kitchen cleaning agent), Barrett’s esophagitis with an ulcer, infections, and pill esophagitis— is extra vulnerable. (Yes, swallowing a pill without enough water can tear up the esophagus.)

Retched topic! Sorry to bring it up and hurl it at you. Watch what you eat and drink!
Dr. Hook cracks a joke or two, but he's a renowned physician with an interesting website, Email him with your questions.