Longitudinal tear in gastroesophageal junction due to vomiting; unrelated to ulcer disease. Risk factors are hiatal hernia, alcohol abuse, and pregnancy. Bleeding is arterial. Lavage and nasogastric decompression stops most bleeding; 2nd-line procedures are vasopressin infusion, endoscopic ablation, and angiographic embolization. Mortality (5% Ð 15%) is largely function of underlying cirrhosis.