Hiccups: An Unappreciated Cause of the Mallory-Weiss Syndrome

Abstract

The Mallory-Weiss syndrome is characterized by bleeding from a mucosal tear of the gastroesophageal junction and may account for an estimated 1%-14% of all upper gastrointestinal bleeding cases. 1 Classically, the syndrome is associated with forceful vomiting or retching before the first episode of hematemesis. The mucosal tear is attributed to shearing forces on the gastroesophageal junction during high intra-abdominal pressures generated by forceful contractions of the diaphragm during vomiting, and less commonly, during severe coughing, status asthmaticus, and generalized convulsion, especially when there is a hiatal hernia. 1,2 However, some 23% of cases have no identifiable risk factor. 1 Here, I describe 3 cases of the Mallory-Weiss syndrome following bouts of severe hiccups.

A Case Report: Life Saving Mallory-Weiss Syndrome

“…There is severe retching, cough, straining, or vomiting before bleeding in Mallory-Weiss syndrome (1). The present case also referred to severe retching and vomiting history before the bleeding in line with the literature.…”

“…Mallory-Weiss syndrome, which is characterized by bleeding as a result of mucosa rupture on the gastroesophageal junction, is the cause of 1% to 4% of the cases with upper gastrointestinal system (GIS) bleeding. This syndrome is usually associated with intense retching, cough, straining, or vomiting (1). The syndrome was first identified by Kenneth Mallory and Soma Weiss in 1929 (2).…”

Mallory-Weiss tear as a rare complication during esophageal endoscopic submucosal dissection.

“…First, coughs and hiccups increase intra-abdominal pressure, resulting in a cardia mucosa tear. A cardia mucosa tear often occurs with vomiturition, emesis, and even hiccups [7, 8]. The sudden increase of intra-abdominal pressure causes pressure damage to the gastroesophageal junction.…”

Mallory-Weiss tear after violent hiccups: a rare association

“…There are several risk factors for the development of Mallory-Weiss tears, the most common risk factor of these tears is chronic or binge alcohol usage [ 5 ]. Hiatal hernia is seen in 40% cases which is also a predisposing factor for the development of the Mallory-Weiss tear [ 4 , 7 ]. Hiccups, however, are rarely associated with the gastroesophageal laceration.…”

“…Hiccups, however, are rarely associated with the gastroesophageal laceration. Our review of the literature revealed only five cases reporting upper gastrointestinal hemorrhage due to Mallory-Weiss laceration after hiccups [ 7 ]. Of these, four cases were associated with adults and one an infant [ 7 – 9 ].…”