What are the symptoms of a Mallory-Weiss tear. How is a Mallory-Weiss tear diagnosed. What causes Mallory-Weiss syndrome. Who is at risk for developing Mallory-Weiss tears. How are Mallory-Weiss tears treated. Can Mallory-Weiss tears be prevented. What complications can arise from untreated Mallory-Weiss tears.

Understanding Mallory-Weiss Tears: An Overview of Stomach Lining Injuries

A Mallory-Weiss tear, also known as Mallory-Weiss syndrome, is a condition characterized by a tear in the lower esophagus. This tear occurs in the mucous membrane that lines the junction between the esophagus and stomach. To fully comprehend this condition, it’s crucial to understand the anatomy and function of the esophagus.

The esophagus is a vital component of the digestive system. It’s a muscular tube that connects the throat to the stomach, facilitating the passage of food and liquids. The esophagus uses rhythmic muscle contractions, known as peristalsis, to propel food downwards into the stomach. When a Mallory-Weiss tear occurs, it disrupts this normal function and can lead to various complications.

The Significance of Mallory-Weiss Tears in Gastrointestinal Health

Mallory-Weiss tears are more common than many people realize. They account for up to 15% of reported upper gastrointestinal bleeding cases. However, the actual incidence may be higher, as many mild cases likely go undiagnosed. Understanding the prevalence and impact of these tears is crucial for both medical professionals and the general public.

Identifying the Causes of Mallory-Weiss Tears

Mallory-Weiss syndrome occurs when strong abdominal pressure causes a tear in the lower esophageal tissue. While the most common causes are frequent or violent vomiting and coughing, several other factors can contribute to the development of these tears.

• Childbirth
• Inflammation in the stomach lining or esophagus
• Chronic hiccups
• Chest or abdominal trauma
• Heavy lifting
• Chemotherapy
• Hiatal hernia

Is there a connection between alcohol consumption and Mallory-Weiss tears? Indeed, alcohol can play a significant role in the development of these tears. Excessive alcohol consumption often leads to vomiting, which increases the risk of developing Mallory-Weiss syndrome. Studies indicate that 50% to 70% of individuals with Mallory-Weiss tears have a history of excessive alcohol consumption.

Recognizing the Symptoms of Mallory-Weiss Tears

Mallory-Weiss tears cause internal bleeding in the lower esophagus, which can manifest in various symptoms. Recognizing these symptoms early is crucial for prompt diagnosis and treatment.

• Chest or abdominal pain
• Vomiting blood (hematemesis)
• Bloody stools
• Black or tarry stools (melena)
• Diarrhea
• Pale skin
• Feeling faint, weak, or dizzy
• Shortness of breath

Do all patients with Mallory-Weiss tears experience pain? Not necessarily. Some individuals with Mallory-Weiss syndrome might not feel any pain despite having severe internal bleeding. This highlights the importance of being aware of other symptoms and seeking medical attention if they occur.

The Spectrum of Severity in Mallory-Weiss Tears

Mallory-Weiss tears can range from mild to severe. In mild cases, untreated tears may lead to anemia, extreme fatigue, and shortness of breath. However, severe cases can result in more serious complications.

What are the potential complications of untreated severe Mallory-Weiss syndrome? Severe cases can lead to:

• Low blood pressure
• Racing pulse
• Difficulty producing urine
• Shock

Given these potential complications, it’s crucial to seek medical attention promptly if you experience symptoms suggestive of a Mallory-Weiss tear.

Diagnostic Approaches for Mallory-Weiss Tears

Diagnosing Mallory-Weiss tears involves a combination of symptom assessment and diagnostic tests. Healthcare providers typically begin by asking about the patient’s symptoms and medical history.

How do doctors confirm the presence of a Mallory-Weiss tear? The primary diagnostic tool is endoscopy. An endoscope, a long tube with a camera attached, is inserted through the mouth and down the esophagus. This allows the doctor to visualize any tears or signs of bleeding directly.

In addition to endoscopy, doctors may also perform other tests to assess the extent of bleeding and its impact on the patient’s overall health. These may include:

• Blood tests to check for anemia
• Stool tests to detect the presence of blood
• Imaging studies such as X-rays or CT scans in some cases

Treatment Options for Mallory-Weiss Tears

The treatment approach for Mallory-Weiss tears depends on the severity of the condition. In many cases, these tears heal on their own without specific medical intervention.

What percentage of Mallory-Weiss tears resolve spontaneously? Approximately 80% to 90% of Mallory-Weiss tears heal without any special medical treatment. However, even in these cases, doctors may recommend medications to reduce stomach acid and promote healing.

For more severe cases or those that don’t stop bleeding on their own, several treatment options are available:

1. Sealing the tears: Using an endoscope, doctors can seal tears through cauterization (using heat or chemicals) or electrocoagulation (using electrical currents).
2. Applying direct pressure: A special catheter with an inflatable balloon is used to apply pressure to the tears, helping to stop the bleeding.
3. Surgical repair: In rare cases where other treatments fail, surgery may be necessary to repair the tears.

Depending on the severity of the bleeding, additional treatments may be required, such as blood transfusions or medications to control bleeding, manage blood pressure, and alleviate pain.

Risk Factors and Prevention of Mallory-Weiss Tears

While Mallory-Weiss tears can affect people of all ages, certain factors increase the risk of developing this condition.

Who is most at risk for Mallory-Weiss tears? The condition is most common in adults between the ages of 50 and 60, although it can occur at any age, including in children. Men are more than twice as likely as women to develop Mallory-Weiss tears.

Prevention of Mallory-Weiss tears primarily involves addressing the underlying causes. Some preventive measures include:

• Limiting alcohol consumption
• Managing conditions that cause frequent vomiting or coughing
• Treating chronic hiccups
• Using proper lifting techniques to avoid abdominal strain
• Managing gastroesophageal reflux disease (GERD) and other conditions that can lead to esophageal inflammation

Long-term Outlook and Complications of Mallory-Weiss Tears

The prognosis for most patients with Mallory-Weiss tears is generally good, especially when the condition is diagnosed and treated promptly. However, understanding potential complications is crucial for optimal management.

What are the potential long-term effects of Mallory-Weiss tears? While most tears heal without significant long-term consequences, some patients may experience:

• Recurrent bleeding
• Anemia
• Increased risk of future tears
• Complications related to treatment procedures

Regular follow-up with healthcare providers is essential to monitor healing and address any ongoing issues. Patients who have experienced a Mallory-Weiss tear should be vigilant about symptoms that could indicate a recurrence.

Advances in Research and Treatment of Mallory-Weiss Tears

Medical research continues to advance our understanding and treatment of Mallory-Weiss tears. Recent studies have focused on improving diagnostic techniques, developing more effective treatment methods, and identifying risk factors to enhance prevention strategies.

What are some recent developments in the management of Mallory-Weiss tears? Emerging areas of research include:

• Novel endoscopic techniques for better visualization and treatment of tears
• Development of new hemostatic agents to control bleeding more effectively
• Improved understanding of the genetic factors that may predispose individuals to Mallory-Weiss tears
• Exploration of minimally invasive surgical techniques for severe cases

These advancements hold promise for improving outcomes and reducing complications associated with Mallory-Weiss tears in the future.

In conclusion, Mallory-Weiss tears represent a significant cause of upper gastrointestinal bleeding. While they can be serious, most cases resolve with appropriate management. Understanding the causes, symptoms, and treatment options is crucial for both patients and healthcare providers. By recognizing the signs early and seeking prompt medical attention, individuals can significantly improve their chances of a full recovery from this condition.

What Is a Mallory-Weiss Tear?

Written by Nicole Wu

Medically Reviewed by Poonam Sachdev on November 23, 2021

• What Are the Causes of a Mallory-Weiss Tear?
• What Are the Symptoms of a Mallory-Weiss Tear?
• How Are Mallory-Weiss Tears Diagnosed?
• What Is the Treatment for a Mallory-Weiss Tear?
• Who Is at Risk of Mallory-Weiss Tears?
• Can Mallory-Weiss Tears Be Prevented?
• More

A Mallory-Weiss tear (also known as Mallory-Weiss syndrome) happens when part of your lower esophagus tears. The esophagus is an essential part of your digestive system. It’s made of tissue that forms a hollow tube and connects the back of your throat to your stomach, using rhythmic muscle contractions to transport your food.

Internal bleeding from Mallory-Weiss tears can cause many different and potentially serious health problems. Here is what you should know about Mallory-Weiss tears, the symptoms they cause, and how they can be diagnosed and treated.

Mallory-Weiss syndrome occurs when strong pressure in your abdomen tears the tissue in your lower esophagus. The most common cause of Mallory-Weiss tears is frequent or violent vomiting and coughing.

Some other possible Mallory-Weiss tear causes are:

• Childbirth
• Inflammation in your stomach lining or esophagus
• Chronic hiccups
• Chest or abdominal trauma
• Heavy lifting
• Chemotherapy
• Hiatal hernia (when your stomach pushes up through muscles that separate your chest and abdomen)

Mallory-Weiss tears cause internal bleeding in your lower esophagus. These tears can have a variety of symptoms such as:

• Chest or abdominal pain
• Vomiting blood that is either bright red or dark-colored and looks like coffee grounds
• Bloody stools
• Stools that look black or tarry
• Diarrhea
• Pale skin
• Feeling faint, weak, or dizzy
• Feeling out of breath

Mallory-Weiss tears cause up to 15% of reported upper gastrointestinal bleeding, and many more people are likely to have mild tears that go undiagnosed. In mild cases, untreated Mallory-Weiss tears can cause anemia, extreme tiredness (fatigue), and shortness of breath. 

Some people with Mallory-Weiss syndrome might not feel any pain but still have severe internal bleeding. Untreated severe Mallory-Weiss syndrome can cause low blood pressure, a racing pulse, difficulty producing urine, and shock. 

If you are vomiting blood, passing bloody stools, or have any other symptoms of a Mallory-Weiss tear, it is important to call your doctor and get medical help as soon as possible. 

Doctors can diagnose Mallory-Weiss tears by asking you about your symptoms and doing some tests to check for the condition. 

Mallory-Weiss tears cause internal bleeding, so your doctor will usually check for signs of blood in your stool. They may also want to use an endoscope to look inside your esophagus for signs of tearing. The endoscope is a long tube that is inserted into your mouth and down your esophagus. It has a special camera attached that lets your doctor see any internal tears or bleeding.

Around 80% to 90% of Mallory-Weiss tears will heal on their own without any special medical treatment. 

If you have a Mallory-Weiss tear, your doctor might want you to take medication to help lower your stomach acid so that your body can heal more effectively. 

If your bleeding doesn’t stop on its own or is severe, your doctor might suggest a few different treatments depending on your condition. Some possible Mallory-Weiss tear treatment options are:

• Sealing the tears. An endoscope (a long tube with an attached camera) lets doctors see and seal any tears you might have. Tears are sealed with cauterization methods that use heat or chemicals, or with electrical currents (electrocoagulation).
• Applying direct pressure to the tears. Doctors use a special catheter with an inflatable balloon. After the catheter is inserted into your esophagus, the balloon is inflated. Pressure on the tears from the balloon helps stop the bleeding.
• Repairing the tears surgically. Surgery is usually the last resort for Mallory-Weiss tears that will not stop bleeding. It is usually not performed unless other forms of less invasive treatment don’t work.

Depending on the severity of your Mallory-Weiss tear, you might need other treatments such as blood transfusions or medications to control your bleeding, blood pressure, and any pain you might feel.

Many people with Mallory-Weiss syndrome are adults between ages 50 and 60, but it can affect people of all ages, including children. 

Men are more than twice as likely to have a Mallory-Weiss tear than women. 

Drinking alcohol can increase your risk for vomiting, which in turn increases your chance of contracting Mallory-Weiss syndrome. An estimated 50% to 70% of people with Mallory-Weiss tears have a history of drinking excessive amounts of alcohol.

The most common causes of Mallory-Weiss tears are frequent and severe vomiting and coughing. You can lower your risk of Mallory-Weiss syndrome by limiting how much alcohol you drink, quitting smoking, and avoiding other things that might make you vomit or cough.

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Mallory-Weiss Tear: Causes, Symptoms, Treatment

Severe and prolonged vomiting can result in tears in the lining of the esophagus. The esophagus is the tube that connects your throat to your stomach.

Mallory-Weiss syndrome (MWS) is a condition marked by a tear in the mucous membrane, or inner lining, where the esophagus meets the stomach.

Most tears heal within 72 hours without treatment, but Mallory-Weiss tears can cause significant bleeding. Depending on the severity of the tear, surgery may be necessary to repair the damage.

The most common cause of MWS is severe or prolonged vomiting. While this type of vomiting can occur with stomach illness, it also frequently occurs due to chronic alcohol use or bulimia.

Other conditions can result in a tear of the esophagus as well. These include:

• trauma to the chest or abdomen
• severe or prolonged hiccups
• intense coughing
• heavy lifting or straining
• gastritis, which is an inflammation of the lining of the stomach
• hiatal hernia, which occurs when part of your stomach pushes through part of your diaphragm
• convulsions

Receiving cardiopulmonary resuscitation (CPR) can also lead to a tear of the esophagus.

MWS is more common in males than in females. It occurs more often in people with alcoholism. According to the National Organization for Rare Disorders, people between the ages of 40 and 60 are more likely to develop this condition. However, there are cases of Mallory-Weiss tears in children and young adults.

There are a few predisposing factors that can put you at risk of Mallory-Weiss tears. These can include:

• heavy alcohol consumption
• bulimia nervosa diagnosis
• persistent acid reflux
• severe vomiting

Having a hiatal hernia is currently up for debate as to whether it’s a risk factor for Mallory-Weiss tears. While many who have a diagnosis of MWS have reported having hernias, it’s still unclear whether there’s a proven link.

MWS doesn’t always produce symptoms. This is more common in mild cases when tears of the esophagus produce only a small amount of bleeding and heal quickly without treatment.

In most cases, however, symptoms will develop. These may include:

• abdominal pain
• vomiting up blood, which is called hematemesis
• involuntary retching
• bloody or black stools

Vomiting blood

Blood in the vomit will usually be dark and clotted and may look like coffee grounds. Occasionally it can be red, which indicates it’s fresh.

Blood that appears in the stool will be dark and look like tar, unless you have a large bleed, in which case it will be red.

If you have these symptoms, seek immediate emergency care. In some cases, blood loss from MWS can be substantial and life threatening.

There are other health problems that may produce similar symptoms.

Symptoms associated with MWS may also occur with the following disorders:

• Zollinger-Ellison syndrome, which is a rare disorder in which small tumors create excess stomach acids that lead to chronic ulcers
• chronic erosive gastritis, which is inflammation of the stomach lining that causes ulcer-like lesions
• perforation of the esophagus
• peptic ulcer
• Boerhaave’s syndrome, which is a rupture of the esophagus due to vomiting

It’s worth noting that MWS is a rare condition, and can only be diagnosed by a doctor. If you exhibit symptoms it’s important to see your physician immediately in order to get a proper diagnosis.

Your doctor will ask you about any medical issues, including daily alcohol intake and recent illnesses, to identify the underlying cause of your symptoms.

If your symptoms indicate active bleeding in the esophagus, your doctor may do what’s called an esophagogastroduodenoscopy (EGD).

You’ll need to take a sedative and a painkiller to prevent discomfort during this procedure. Your doctor will insert a small, flexible tube with a camera attached to it, called an endoscope, down your esophagus and into the stomach. This can help your doctor see your esophagus and identify the location of the tear.

Your doctor will likely also order a complete blood count (CBC) to confirm the number of red blood cells. Your red blood cell count may be low if you have bleeding in the esophagus.

Your doctor will be able to determine if you have MWS based on the findings from these tests.

According to the National Organization for Rare Disorders, the bleeding that results from tears in the esophagus will stop on its own in about 80 to 90 percent of MWS cases.

Healing typically occurs in a few days and doesn’t require treatment. But if the bleeding doesn’t stop, you may need one of the following treatments.

Endoscopic therapy

You may need endoscopic therapy if the bleeding doesn’t stop on its own. The doctor performing the EGD can do this therapy. Endoscopic options include:

• injection therapy, or sclerotherapy, which delivers medication to the tear to close off the blood vessel and stop the bleeding
• coagulation therapy, which delivers heat to seal off the torn vessel

Extensive blood loss may require the use of transfusions to replace lost blood.

Surgical and other options

Sometimes, endoscopic therapy isn’t enough to stop the bleeding. So doctors use other ways of stopping it, such as laparoscopic surgery to sew the tear.

If you can’t undergo surgery, your doctor may use arteriography to identify the bleeding vessel and plug it to stop the bleeding.

Medication

Medications to reduce stomach acid production, such as famotidine (Pepcid) or lansoprazole (Prevacid), may also be necessary. However, the effectiveness of these medications is still under debate.

There isn’t a lot that can be done to completely prevent MWS. However, there are a few lifestyle and health measures you can take in order to lower your risk of having MWS or improve your prognosis if you receive a diagnosis of MWS.

To prevent MWS, it’s important to treat conditions that cause long episodes of severe vomiting. To do this, visit your doctor for treatment or seek help for eating disorders, such as bulimia.

Excessive alcohol use and cirrhosis can trigger recurring episodes of MWS. Consider limiting your alcohol consumption to lower your risk of MWS. If you have MWS, avoid alcohol and talk with your doctor about ways to manage your condition to prevent future episodes.

Rupture of the esophagus. What is an Esophageal Rupture?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Rupture of the esophagus is a violation of the integrity of the esophageal wall of a traumatic or spontaneous nature. Rupture of the esophagus is manifested by sudden severe pain behind the sternum and in the epigastrium, respiratory failure, cyanosis of the face, lips and extremities, the appearance of subcutaneous emphysema on the neck. In order to diagnose a rupture of the esophagus, it is indicated to perform a survey radiography of the abdominal cavity and chest, fluoroscopy of the esophagus with water-soluble contrast, and in doubtful cases, esophagoscopy. If a fresh rupture of the esophagus is detected, the esophageal wall defect is sutured, gastrostomy is performed, and the pleural cavity is drained; with advanced rupture of the esophagus – drainage of the mediastinum, esophagostomy, gastrostomy.

• Causes of esophageal rupture
• Symptoms of esophageal rupture
• Diagnosis of rupture of the esophagus
• Treatment of ruptured esophagus
• Prediction and prevention of esophageal ruptures
• Prices for treatment

General

Rupture of the esophagus is an emergency condition requiring a number of emergency surgical measures. Late diagnosis of esophageal rupture leads to severe purulent complications (neck phlegmon, mediastinitis, pleural empyema, sepsis), esophago-respiratory fistulas, bleeding and high mortality. In gastroenterology, perforation of the esophagus and spontaneous rupture of the esophagus (Boerhaave’s syndrome) are distinguished, which differ in their causes.

Causes of esophageal rupture

The causes of esophageal perforation can be iatrogenic medical diagnostic procedures – esophagoscopy, tracheostomy, bougienage of the esophagus, cardiodilatation, tracheal intubation, damage to the esophageal wall during operations on the neck, chest organs, and abdomen. Chemical burns of the esophagus, ulcers, tumors and foreign bodies of the esophagus can also lead to necrosis of the esophageal wall and its perforation. In some cases, rupture of the esophagus is caused by penetrating wounds of the neck and chest.

Spontaneous rupture of the esophagus occurs with a sudden sharp increase in intraesophageal pressure. The main cause of spontaneous rupture of the esophagus is severe vomiting that develops when overeating and taking large amounts of alcohol. With the reflux of gases and gastric contents into the esophagus and spasm of the lower esophageal sphincter, intraesophageal pressure rises sharply, resulting in a rupture of the esophagus in its weakest section, located above the diaphragm. This situation often develops with a conscious desire to restrain the urge to vomit during meals, at the table, so this pathology is called “banquet esophagus”. Less commonly, spontaneous rupture of the esophagus occurs when straining (during weight lifting, during childbirth), coughing, epileptic seizure, blunt abdominal trauma. Spontaneous ruptures of the esophagus in more than 80% of cases are diagnosed in men aged 50-60 years.

There are complete and incomplete ruptures of the esophagus. In the first case, damage affects the entire thickness of the organ wall; in the second, the rupture occurs within one or more membranes of the esophagus.

Symptoms of esophageal rupture

After exposure to a traumatic factor (endoscopic procedure, vomiting, etc.), a sudden sharp retrosternal or epigastric pain develops, often radiating to the shoulder girdle or lumbar region. Breathing becomes superficial and difficult, the pulse is frequent; cyanosis of the skin (face, lips, limbs) develops, cold sweat appears. In the neck area, subcutaneous emphysema is rapidly growing, due to the release of air into the subcutaneous fat. During swallowing, coughing, deep breathing, chest pains intensify; in some cases, hypersalivation and hematemesis are noted.

In the case of a rupture of the esophagus that occurred against the background of a penetrating wound of the chest, symptoms of lung damage due to hemo- and pneumothorax predominate.

With spontaneous rupture of the esophagus, the left wall of the supradiaphragmatic part of the esophagus is predominantly affected, as a result of which a message is formed between the esophagus and the left pleural cavity, where food enters. As a result, pleural empyema, severe intoxication, and septic shock develop. With the localization of the rupture of the esophagus in the cervical region, an esophageal or paraesophageal phlegmon of the neck is formed; rupture of the thoracic esophagus develops mediastinitis, abdominal esophagus – peritonitis.

Late signs of rupture of the esophagus, indicating an inflammatory process in the mediastinum and abdominal cavity, include fever, tachycardia, shortness of breath, a critical deterioration in the patient’s condition, intoxication and shock.

Esophageal rupture diagnosis

In the diagnosis of rupture of the esophagus, they rely on the data of the anamnesis, physical examination, and instrumental examinations. Palpation is determined by pain in the epigastric region, subcutaneous emphysema, tension in the muscles of the abdominal wall; with percussion – a box sound over the lungs, with auscultation – a sharp weakening of breathing.

Plain radiography of the chest and abdomen reveals accumulation of gas in the mediastinum (pneumomediastinum) and paraesophageal space, hydropneumothorax. An X-ray of the esophagus with water-soluble contrast allows you to see the exit of the substance beyond the esophageal wall and clarify the location of the rupture of the esophagus. In doubtful cases, pharyngoscopy, esophagoscopy, mediastinoscopy are performed.

If a rupture of the esophagus is suspected, other diseases that occur with retrosternal and abdominal pain are excluded: myocardial infarction, exfoliating aneurysm, perforated gastric ulcer, acute pancreatitis, spontaneous pneumothorax, rupture of the trachea and bronchi. In this regard, ECG, ultrasound of the aorta, examination of pancreatic enzymes, chest x-ray, bronchoscopy, ultrasound of the pleural cavities, etc. are additionally performed. If necessary, exclusion of gastric perforation may require laparoscopy.

Treatment of esophageal rupture

Conservative tactics are acceptable for fresh injuries at the level of the hypopharynx (laryngeal part of the pharynx) or cervical region, as well as for incomplete rupture of the esophagus. In these cases, the patient is urgently hospitalized, food through the mouth is excluded, painkillers and antibiotic therapy are prescribed. The patient is monitored dynamically for the purpose of early detection of indications for surgical intervention. In the case of increased pain, an increase in subcutaneous emphysema, an increase in body temperature, an urgent operation is performed. In case of rupture of the cervical esophagus, a cervical mediastinotomy is indicated with the installation of a double-lumen drainage to the perforation site.

In case of rupture of the thoracic esophagus on the first day after the injury, a thoracotomy, suturing and covering the defect with a pleural or pericardial flap, gastrostomy, drainage of the pleural cavity and mediastinum are performed. If more than 24 hours have passed since the rupture of the esophagus, palliative interventions are performed (without suturing the esophagus): esophagostomy, mediastinotomy, gastrostomy, jejunostomy, drainage of the pleural cavity and mediastinum.

In the postoperative period, the cavities are washed with antiseptics, the introduction of proteolytic enzymes, antibiotic therapy, infusion therapy.

Prognosis and prevention of esophageal ruptures

Mortality in spontaneous ruptures of the esophagus ranges from 25 to 85%, depending on the timing of the start of medical care. Late diagnosis of esophageal rupture and the development of secondary complications (neck phlegmon, pleural empyema, mediastinitis, sepsis, esophageal-bronchial fistulas, bleeding, etc.) worsen the chances of recovery.

Prevention of iatrogenic injuries of the esophagus consists in the careful conduct of endoscopic procedures, tracheostomy, intubation, and surgical interventions. Prevention of spontaneous rupture of the esophagus requires the exclusion of provoking factors – overeating, drinking large amounts of alcohol, sudden physical effort, etc.

Sources

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