Mallory-Weiss syndrome differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamed Diab, MD [2]

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Overview

Mallory-Weiss syndrome must be differentiated from other causes of Upper gastrointestinal bleeding such as PUD, Esophagogastric varices, Severe or erosive gastritis/duodenitis, Angiodysplasia.

Differential Diagnosis

Mallory-Weiss syndrome must be differentiated from other diseases that cause esophageal ulcers such as:

• Reflux esophagitis: Ulcerations are usually in distal esophagus, and maybe irregular and multiple, unlike Mallory-Weiss syndrome. Patients have history of heartburn and regurgitation.
• Infectious esophagitis: Ulcerations are multiple and usually involve the proximal esophagus.
• Medication-induced esophagitis: Ulcerations are usually singular and deep with a history of drug use such as tetracycline.

Mallory-Weiss syndrome must be differentiated from other causes of Upper gastrointestinal bleeding:

•  PUD
• Esophagogastric varices
• Severe or erosive gastritis/duodenitis
• Angiodysplasia

Differential Diagnosis	Similar Features	Differentiating Features
Reflux esophagitis	Ulcerations seen in reflux esophagitis are usually in the distal esophagus also observed in Mallory-Weiss syndrome.	Ulcerations are usually in distal esophagus, and maybe irregular and multiple, patients have history of heartburn, dysphagia and regurgitation that distinguish it from Mallory-Weiss syndrome.
Infectious esophagitis	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	Ulcerations are multiple and usually involve the proximal esophagus that distinguish it from Mallory-Weiss syndrome.
Medication-induced esophagitis	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	Ulcerations are usually singular and deep with a history of drug use such as tetracycline that distinguish it from Mallory-Weiss syndrome.

Preferred Table

Diseases	History and Symptoms					Physical Examination				Laboratory Findings				Other Findings
	Hematemesis	Epigastric pain	Light-headedness	Retching	Vomiting	Physical Finding 1	Physical Finding 2	Physical Finding 3	Physical Finding 4	Lab Test 1	Lab Test 2	Lab Test 3	Lab Test 4
Mallory-Weiss syndrome	+	+	+	+	+
Infectious esophagitis		+
Medication-induced esophagitis		+
Reflux esophagitis		+

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