What is the Difference Between Mallory Weiss and Boerhaave

The key difference between Mallory Weiss and Boerhaave is that Mallory Weiss is a syndrome in which there is a tear in the inner lining of the esophageal wall, while Boerhaave is a syndrome in which there is a full-thickness rupture of the esophageal wall.

Esophageal rupture is the rupture of the esophageal wall. It can be due to fatal vomiting of blood. The common symptoms of esophageal rupture are chest pain, vomiting blood, low blood pressure, and fever. Mallory-Weiss and Boerhaave are two syndromes associated with esophageal rupture.

1. Overview and Key Difference
2. What is Mallory Weiss
3. What is Boerhaave
4. Similarities – Mallory Weiss and Boerhaave
5. Mallory Weiss vs Boerhaave in Tabular Form
6. Summary – Mallory Weiss vs Boerhaave

What is Mallory Weiss?

Mallory Weiss refers to a syndrome that occurs due to a rupture or laceration of the mucous membrane at the point where the esophagus and stomach meet. However, this syndrome does not rupture the full thickness of the esophagus wall. The rupture in the Mallory Weiss syndrome only occurs in the mucosa and submucosa, not penetrating the muscular layer. Such lacerations may result in severe bleeding from the gastrointestinal tract. The symptoms of Mallory Weiss syndrome are abdominal pain, severe vomiting (coffee ground colour), vomiting with blood (hematemesis), dark stool as tar, shock, collapse, and severe, painless internal gastrointestinal bleeding (hemorrhage).

The main cause of Mallory Weiss syndrome is chronic severe vomiting. This is also associated with chronic alcoholism, severe trauma to the chest or abdomen, chronic hiccups, intense snoring, lifting and straining, inflammation of the lining of the stomach or esophagus, hiatus hernia, convulsions, CPR (cardiopulmonary resuscitation) or chemotherapy. Mallory Weiss syndrome can be diagnosed through endoscopy and esophagogastroduodenoscopy. Cauterization or injection of epinephrine, embolization of the arteries supplying the region, and high gastrostomy are several treatment options available for Mallory Weiss syndrome.

What is Boerhaave?

Boerhaave is a syndrome involving a full-thickness tear of the esophagus wall, normally caused by tremendous stress. This is usually due to straining resulting from forceful or repeated vomiting. The other possible causes are childbirth, seizures, weightlifting, and ingestion of something caustic or corrosive. The possible symptoms of Boerhaave syndrome are sudden, severe chest pain, nausea, vomiting, pain, coughing when swallowing, short, rapid breathing, swelling in the tissues of the chest cavity due to air and fluid, hard or rigid abdomen, fever, and sweating. The complications resulting from this condition are inflammation in the chest cavity, empyema, trapped air in the chest cavity, pleural effusion, acute respiratory distress syndrome (ARDS), and septicaemia or septic shock.

Boerhaave syndrome can be diagnosed through standard chest X-ray, esophagram, and CT scan. Furthermore, the treatments for Boerhaave syndrome include IV fluids, antibiotics, surgery repair for rupture, drainage/debridement, advanced management (esophagectomy) alternative nutrition (tube or vein).

What are the Similarities Between Mallory Weiss and Boerhaave?

Mallory Weiss and Boerhaave are two syndromes that cause esophageal rupture.
Both conditions can be caused by forceful or repeated vomiting.
They show similar symptoms, such as chest pain, vomiting blood, low blood pressure, and fever.
Both conditions are diagnosed through imaging tests such as X-rays.
They are mainly treated through surgical repair.

What is the Difference Between Mallory Weiss and Boerhaave?

Mallory Weiss syndrome does not involve the rupturing of the full thickness of the esophagus wall, while Boerhaave syndrome is a rupture of the full thickness of the esophagus wall. Thus, this is the key difference between Mallory Weiss and Boerhaave. Furthermore, Mallory Weiss syndrome occurs due to chronic severe vomiting, chronic alcoholism, severe trauma to the chest or abdomen, chronic hiccups, intense snoring, lifting and straining, inflammation of the lining of the stomach or esophagus, hiatus hernia, convulsions, CPR or chemotherapy. On the other hand, Boerhaave syndrome occurs due to straining resulting from forceful or repeated vomiting, childbirth, seizures, weightlifting, and ingestion of something caustic or corrosive.

The below infographic presents the differences between Mallory Weiss and Boerhaave in tabular form for side by side comparison.

Summary – Mallory Weiss vs Boerhaave

Mallory Weiss and Boerhaave are two syndromes that cause esophageal rupture. Mallory Weiss syndrome does not involve the rupture of the full thickness of the esophagus wall. There is a tear in the inner lining of the esophageal wall. Rupture does not penetrate the esophagus. Boerhaave syndrome refers to a rupture of the full thickness of the esophagus wall. It is a spontaneous rupture of the esophagus. It occurs due to forceful vomiting or intense straining. So, this is the key difference between Mallory Weiss and Boerhaave.

Reference:

1. “Mallory Weiss Syndrome.” UpToDate.
2. “Boerhaave’s Syndrome: Symptoms, Treatment & Definition.” Cleveland Clinic.

Image Courtesy:

1. “Estomago3” By Jason2525 – Own work (CC BY-SA 3.0) via Commons Wikimedia
2. “BoorhaaveSag CT” By Jto410 – Own work (CC BY-SA 3.0) via Commons Wikimedia