What Causes Boerhaave’s Syndrome?

Boerhaave's syndrome, or a spontaneous esophageal rupture, is a condition where the esophagus incurs a tear that penetrates all the way through it. An esophageal rupture is extremely problematic because it allows stomach acid, air, and food to leak out of the esophagus and into the chest. This causes severe inflammation and fluid accumulation around the lungs. Symptoms of Boerhaave's syndrome include abdominal pain, low blood pressure, fever, chest pain, vomiting, and vomiting blood. Boerhaave's syndrome can be diagnosed using an esophagography and x-rays of the individual's abdomen and chest. The only treatment for Boerhaave's syndrome is the surgical repair of the tear in the patient's esophagus. Prior to the surgical procedure, the affected individual is given broad-spectrum antibiotics to reduce the chance of infection. There are numerous mechanisms that can cause Boerhaave's syndrome.

Forceful And Excessive Vomiting

Boerhaave's syndrome caused by forceful and excessive vomiting is a rare occurrence. Typically, this type of vomiting typically occurs after an individual drinks excessive amounts of alcohol or eats an excessive amount of food. In some cases, violent vomiting can be caused by certain medical treatments and medications like chemotherapy. Widespread infections and consumption of illegal drugs can also result in excessive vomiting. Any one of these factors can induce severe and intense vomiting that causes the intraluminal esophageal pressure or the pressure inside of the individual's esophagus to rapidly and suddenly rise. The cricopharyngeus muscle fails to relax, and the excessive pressure usually causes a tear in the left lower section of the individual's esophagus. Another common region where an esophageal tear can occur due to forceful and excessive vomiting is in the bottom of the esophagus underneath the point where the individual's diaphragm is located. Should the tear happen above the diaphragm, respiratory symptoms and chest pain will result. If the tear occurs below the diaphragm, the individual will experience symptoms in the abdominal region including pain and a burning sensation.

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Epileptic Seizures

An epileptic seizure can cause an individual to incur a tear in their esophagus. A seizure happens when the patient's brain has an abnormal electrical discharge. Similar to a short circuit, the patient will experience a behavioral change without being aware of it. Some seizures do not cause erratic movements, but others can cause violent and jerking movements. Epilepsy is a disorder characterized by frequent seizure activity in an individual. Because this electrical discharge in the brain of a patient having a seizure causes erratic muscular dysfunction, the muscle coordination of the esophagus and surrounding muscles will be lost. In a healthy individual who is not having a seizure, certain muscles in the esophagus help ensure its interior pressure does increase to a dangerous level. However, in an individual who is epileptic and experiencing a violent seizure, this mechanism to prevent excessive pressure build up in the esophagus will not be functional. Consequently, a mild injury to the esophagus can occur or the esophagus can tear all the way through during a seizure, causing Boerhaave's syndrome.

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