[Clinical, morphological, and microbiological characteristics of the Mallory-Weiss syndrome].

The profound clinico-morphological and immunological analysis was performed in patients suffering Mallory-Weiss syndrome (MWS). Doing endoscopic and morphological investigations the most dangerous foci of the affection were revealed and there links with the disease course severity and the recurrences rate established. The signs of unstable haemostasis were revealed according to the endoscopic investigation data. Morphological changes of gastric mucosa in patients suffering MWS are similar to those in duodenal ulcer disease. Polymorphism of mucosal microorganisms with E. coli, Streptococcus beta-haemoliticus, Klebsiella pneumoniae, Candida albicans predominance, which severe the disease course and cause the haemorrhage recurrence, was characteristic for MWS in 85% of observations. These causing agents are sensitive to II-III generation cephalosporins and fluoroquinolons in 75% of observations. The complex of conservative treatment must include, besides restorational, untiulcer, antihelicobacter and antibacterial therapy.

Endoscopic injection therapy in bleeding Mallory-Weiss syndrome: a randomized controlled trial.

BACKGROUND: Endoscopic injection is widely used in the therapy of bleeding gastroduodenal ulcers, but its role in the management of bleeding Mallory-Weiss tears has not been properly assessed. METHODS: Sixty-three patients undergoing emergency endoscopy in whom there was a high index of suspicion that a Mallory-Weiss tear was the source of bleeding were randomly assigned to undergo endoscopic injection therapy (epinephrine and polidocanol) or no endoscopic therapy in 2 university-affiliated hospitals. Rates of recurrent bleeding, transfusion requirements, complications, mortality, and length of hospital stay were determined for both groups of patients. RESULTS: Bleeding recurred in 8 patients in the control group versus only 2 in the endoscopic treatment group (25.8% vs. 6.2%, p < 0.05). Hospital stay was longer for the control group (5.5 +/- 0.2, median 6.0, range 2.0-8.0 days vs. 3.4 +/- 0.2, median 3.0, range 2.0-6.0 days; p < 0.001). There was a trend toward a higher transfusion requirement after endoscopy in the control group versus the patients treated by injection (0.9 +/- 0.2, median 0.0, range 0.0-4.0 units vs. 0.2 +/- 0.1, median 0.0, range 0.0-2.0 units; p = 0.09). No complications or adverse events caused by endoscopic injection were noted. Two patients in the control group died of causes unrelated to bleeding. CONCLUSIONS: Endoscopic injection therapy is a useful option in the management of patients with Mallory-Weiss syndrome at high risk for recurrent bleeding.

Efficacy of endoscopic isotonic saline-epinephrine injection for the management of active Mallory-Weiss tears.

Therapeutic endoscopy with isotonic saline-epinephrine (ISE) injection is a convenient and widely used procedure for hemostasis in upper gastrointestinal bleeding. We retrospectively evaluated 36 patients (from January 1996 to April 1999) who had been diagnosed with recent or active bleeding due to Mallory-Weiss tears in emergency endoscopic examination. The endoscopic hemostatic method with ISE injection was performed in 15 of 36 patients. The other 21 patients received conservative treatment with hemodynamic support. Patient's clinical data, laboratory data, transfusion requirements, endoscopic findings, and length of hospital stays were evaluated. Initial hemoglobin was significantly lower in the ISE group than the conservative treatment group (9.74 +/- 2.86 g/dL vs. 12.57 +/- 2.80 g/dL, respectively; p < 0.01). Mean transfusion requirements were significantly higher in the ISE group than the conservative treatment group (7.26 +/- 8.78 units vs. 2.85 +/- 6.21 units, respectively; p < 0.1). Patients in the ISE group were supposed to be having a more severe bleeding episode. Most patients achieved initial hemostasis in the ISE group and the conservative treatment group (93% and 95%, respectively). The rebleeding rate was also similar in both groups (1 in 15 in the ISE group and I in 21 in the conservative treatment group). There was no significant difference in length of hospital stay and rebleeding between these two groups (3.47 +/- 1.92 days vs. 2.47 +/- 1.47 days, respectively: p = 0.89). The endoscopic ISE injection is an inexpensive, simple, convenient therapeutic method and it can achieve initial hemostasis for active Mallory-Weiss tears.

Systemic vasopressin therapy for Mallory-Weiss bleeding.

Over a period of one year, five of 101 patients admitted to our center because of upper gastrointestinal bleeding were found to have a Mallory-Weiss tear. This condition usually responds to conservative management. Torrential bleeding necessitating surgery is uncommon. Three of the patients, reported here, bled torrentially and were considered surgical candidates. Two received systemic vasopressin while being prepared for operation, with rapid, dramatic cessation of bleeding. Although this is a limited experience, we are impressed enough to believe that intravenous vasopressin should be given a trial in all hospitalized patients who continue to bleed from a tear in the region of the esophagogastric junction.

Intraarterial vasopressin infusion for treatment of Mallory-Weiss tears of the esophagogastric junction.

Five patients with refractory gastrointestinal bleeding from Mallory-Weiss tears of the esophagus were successfully treated with intraarterial infusions of vasopressin. Although transcatheter embolization has been shown to control the hemorrhage from these lesions, increased experience with and ease of vasopressin infusion suggest that infusion therapy should be the primary treatment method when more conservative measures are inadequate. Embolization techniques may be reserved for cases in which vasopressin therapy is contraindicated or unsuccessful.

[Treatment of peptic ulcer with histamine H2 receptor antagonists]. / Behandlung des Ulcus pepticum mit Histamin-H2-Rezeptor-Antagonisten.

Histamine H2-receptor antagonists (Burimamide, Metiamide and Cimetidine as the most recent generation) may drastically inhibit gastric acid secretion stimulated by histamine, pentagastrin, insulin, 2-deoxyglucose or an intragastrically instilled meal, respectively. This inhibitory action may explain the beneficial effects of H2-antagonists in the treatment of active peptic ulceration. On Cimetidine administered at a usual dosage over a 4--6 week period, serious side-effects must not be expected. At present studies aim to establish a Cimetidine dosage which, on long-term treatment, may reduce ulcer recurrency.