Overview
Definition
A non-transmural, mucosal laceration at the gastroesophageal junction, typically presenting with hematemesis after repeated retching.
Epidemiology
Accounts for 5-10% of cases of upper gastrointestinal bleeding. Highly associated with alcohol abuse.
Etiology & Risk Factors
- Sudden increase in intra-abdominal pressure causing mucosal tearing at the GE junction during severe vomiting or retching
Clinical Symptoms
- Acute-onset hematemesis (vomiting blood) following episodes of non-bloody vomiting
- Epigastric pain
Clinical Approach
Diagnosis
- Upper endoscopy (EGD) showing a longitudinal mucosal tear at or just below the Z-line
Management
- Supportive care (most bleedings stop spontaneously)
- Endoscopic therapy (epinephrine injection, hemoclips, thermal coagulation) if active bleeding
- Acid suppression (IV PPI)
Complications
- Severe hemorrhage requiring transfusion
- Myocardial ischemia (from acute blood loss)
- Esophageal perforation (rare)