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Boerhaave syndrome: Effort rupture of the esophagus

George Triadafilopoulos, MD
Section Editor
J Thomas Lamont, MD
Deputy Editor
Shilpa Grover, MD, MPH, AGAF


Effort rupture of the esophagus or Boerhaave syndrome is associated with high morbidity and mortality and is fatal in the absence of therapy. The occasionally nonspecific nature of the symptoms may contribute to a delay in diagnosis and a poor outcome [1].

This topic will review the epidemiology, pathogenesis, clinical manifestations, diagnosis, and management of Boerhaave syndrome. The clinical manifestations, diagnosis, and management of traumatic and iatrogenic causes of esophageal perforation are discussed in detail, separately. (See "Overview of esophageal perforation due to blunt or penetrating trauma" and "Surgical management of esophageal perforation" and "Overview of gastrointestinal tract perforation".)


Effort rupture of the esophagus, or Boerhaave syndrome, is a spontaneous perforation of the esophagus that results from a sudden increase in intraesophageal pressure combined with negative intrathoracic pressure (eg, severe straining or vomiting).


Esophageal perforations are rare, with an incidence of 3.1 per 1,000,000 per year [2]. Among esophageal perforations, approximately 15 percent are spontaneous perforations [3].


Boerhaave syndrome usually occurs in patients with a normal underlying esophagus. However, a subset of patients with Boerhaave syndrome has underlying eosinophilic esophagitis, medication-induced esophagitis, Barrett's or infectious ulcers. Sudden increase in intraesophageal pressure combined with negative intrathoracic pressure such as that associated with severe straining or vomiting, and less frequently with childbirth, seizure, prolonged coughing or laughing, or weightlifting, results in a longitudinal esophageal perforation [4,5].

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Literature review current through: Oct 2017. | This topic last updated: Apr 26, 2016.
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