Following severe retching and a strenuous lifting session, which diagnosis best explains hematemesis in this patient?

• A. Mallory-Weiss syndrome
• B. Peptic ulcer disease
• C. Esophageal varices
• D. Erosive gastritis

Answer: (A)

Forceful retching can produce a longitudinal tear at the gastroesophageal junction, causing upper gastrointestinal bleeding. This Mallory-Weiss mechanism fits the pattern of hematemesis following a severe retching and straining event. The tear bleeds because the sudden rise in intragastric pressure and traction at the GE junction disrupt the mucosa, often bleeding but sometimes resolving on its own. In contrast, peptic ulcers cause bleeding more from a chronic ulcer with pain and risk factors like NSAID use; esophageal varices bleed typically in the setting of portal hypertension with often massive bleeding and liver disease history; erosive gastritis can bleed but is not classically precipitated by a single retching episode. If bleeding persists, endoscopy can diagnose and treat the tear, alongside supportive stabilization such as IV fluids and acid suppression.