A Hiatal Hernia is seen with longitudinal tear. Hiatal hernia has been found in 40 to 100 percent of patients with Mallory-Weiss tears and has been considered by some to be a necessary predisposing factor. It has been proposed that, in hiatus hernia, a higher pressure gradient develops in the hernia compared with that in the rest of the stomach during retching, thereby increasing the potential for mucosal laceration. Gastroesophageal tears may also be more likely to occur when the upper esophageal sphincter does not relax during vomiting.
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