How does a gap occur?
During vomiting, the abdominal muscles sharply compress the stomach, the pressure inside it jumps, and the upper part of the stomach and the lower part of the esophagus are stretched. The mucous membrane in the transition zone is thin and weakly fixed, so longitudinal cracks form on it, ranging in length from a few millimeters to 3–4 centimeters. They capture the mucous and submucosal layer where the blood vessels pass, hence the bleeding. The muscle wall usually remains intact, which distinguishes this syndrome from the more serious rupture of the esophagus.
- A sharp rise in pressure in the stomach
- Longitudinal tears of the mucous membrane in the transition zone
- Damage to submucosal vessels
- The muscle layer is usually preserved
- Hiatal hernia increases risk
Causes and triggering situations
The most common situation is repeated vomiting after drinking large amounts of alcohol. But the syndrome also occurs in people who do not drink: with an intestinal infection with uncontrollable vomiting, food poisoning, severe toxicosis of pregnancy, motion sickness, after chemotherapy. Less commonly, ruptures provoke a severe coughing attack, straining due to constipation, heavy lifting, an epileptic seizure, and even intense abdominal exercises. The risk of bleeding is higher in people with bleeding disorders and taking blood thinners.
- Repeated vomiting after alcohol
- Intestinal infections and food poisoning
- Toxicosis of pregnant women
- Severe cough and straining
- Hiatal hernia
- Taking anticoagulants and antiplatelet agents
- Liver cirrhosis with coagulation disorder
Symptoms
The sequence is typical: first, several vomiting attacks without blood, then scarlet blood, clots or contents the color of coffee grounds appear in the vomit. You may experience pain in the upper abdomen and behind the sternum, weakness, and dizziness. If the blood loss is significant, pallor, cold sweat, rapid heartbeat and a drop in blood pressure appear. Some of the blood enters the intestines, so after a few hours the stool turns black. With minor bleeding, the only sign may be a streak of blood.
- Vomiting with scarlet blood after several vomiting attacks
- Clots or contents the color of coffee grounds
- Pain in the epigastrium and behind the sternum
- Weakness and dizziness
- Black stool after a few hours
- Paleness, cold sweat, palpitations due to severe blood loss
Diagnostics
The main method is endoscopy, performed within the next few hours. The doctor sees the characteristic longitudinal tears and assesses whether bleeding continues. At the same time, the study excludes other sources: gastric and duodenal ulcers, varicose veins of the esophagus with cirrhosis, tumor. Laboratory monitoring of hemoglobin, which may not yet decrease in the first hours, coagulation parameters and blood group. If a complete rupture of the esophageal wall is suspected, an x-ray or computed tomography scan of the chest is prescribed.
- Emergency endoscopy of the stomach and esophagus
- General blood test over time
- Blood clotting indicators
- Determination of blood group and Rh factor
- Computed tomography for suspected wall rupture
- Assessment of liver function in cases of suspected cirrhosis
Treatment and prevention of recurrences
In approximately most patients, bleeding stops without intervention. Treatment includes rest, not eating for a short period of time, fluid replacement, antiemetics, and proton pump inhibitors to reduce acidity and aid healing. If active bleeding or a vessel is visible during endoscopy, endoscopic stop is performed: clipping, injections, coagulation. Blood transfusion is required when there is significant blood loss, and surgery is extremely rare. To prevent recurrences, it is important to avoid alcohol abuse, timely treatment of vomiting, and discuss the medications you are taking with your doctor.
- Hospitalization and observation for bleeding
- Antiemetic drugs to stop vomiting
- Proton pump inhibitors
- Endoscopic hemostasis during active bleeding
- Replenishment of fluid volume, transfusion if necessary
- Quitting alcohol and treating the cause of vomiting
