Pharmacologic Highlights

No medications are used to manage Mallory-Weiss syndrome directly. Patients may be placed on vasopressin to reduce upper GI bleeding, antacids or histamine2 blockers to decrease gastric acidity, and in unusual cases of severe hemorrhage, fluid resuscitation and vasopressors to support the circulation.


A major cause of morbidity and mortality in patients with active GI bleeding is aspiration of blood with subsequent respiratory compromise, which is seen in patients with inadequate gag reflexes or those who are unconscious or obtunded. Constant surveillance to ensure a patent airway is essential. Check every 8 hours for the presence of a gag reflex. Maintain the head of the bed in a semi-Fowler position unless contraindicated. If the patient needs to be positioned with the head of the bed flat, place the patient in a side-lying position.

Encourage bedrest and reduced physical activity to limit oxygen consumption. Plan care around frequent rest periods, scheduling procedures so the patient does not overtire. Avoid the presence of noxious stimuli that may be nauseating. Support nutrition by eliminating foods and fluids that cause gastroesophageal discomfort. Encourage the patient to avoid caf-feinated beverages, alcohol, carbonated drinks, and extremely hot or cold food or fluids. Help the patient understand the treatments and procedures. Provide information that is consistent with the patient's educational level and which takes into account the patient's state of anxiety.

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