Boerhaave syndrome is a tear in the esophagus caused by violent vomiting, with symptoms including chest pain and subcutaneous emphysema. Early treatment is crucial for survival, with mortality rates estimated at 30%. Alcohol consumption and male gender increase the risk. Mallory-Weiss syndrome is similar but occurs in the mucous membrane and is rarely fatal.
Boerhaave syndrome is a tear or tear in the wall of the esophagus. Although numerous factors can cause an esophageal injury, tears diagnosed as Boerhaave syndrome are typically attributed to repeated, violent vomiting. The tears typically occur on the left side of the lower third of the esophagus, causing more vomiting, chest pain, and subcutaneous emphysema, or trapped air under the skin of the chest. These symptoms are collectively known as Mackler’s triad. Failure to properly treat the tears associated with Boerhaave syndrome can lead to death.
Herman Boerhaave, a Dutch physician, first documented the condition in the 18th century. The foundation of Boerhaave’s work included studying the relationship between various lesions and patient symptoms. In 18, Boerhaaver wrote of a Dutch admiral and baron named Jan von Wassenaer who, after hours of partying, vomited repeatedly and vigorously. An injury to his esophagus, caused by vomiting, ultimately led to von Wassenaer’s early death. In Boerhaave’s time, all cases of the syndrome were considered uniformly fatal, until modern surgeries were devised.
Even with surgery, about 30 percent of Boerhaaven cases are estimated to result in mortality. Most of the morbidity rates associated with these esophageal ruptures are the result of late diagnosis. Early treatment of the lesion is crucial for patient survival. Few patients survive without prompt surgery to repair the damage.
Not all patients present with the classic triad of symptoms, making diagnosis difficult. Also, late-stage symptoms, such as sepsis and shock, make diagnosis more difficult. Experts estimate that if treatment lasts longer than 12-24 hours after a rupture, the patient’s risk of death increases by 50%. Waiting 48 hours after the rupture to start treatment typically results in mortality rates greater than 90%.
According to research, men are more likely to experience a breakup due to Boerhaave syndrome than women. The ratio of male to female patients averages 2:1. Patients with a history of heavy alcohol consumption are also more likely to experience such esophageal ruptures than patients who do not drink regularly. Studies estimate that up to 40 percent of Boerhaave syndrome patients are heavy drinkers, with alcoholics less likely to recognize symptoms in time to seek lifesaving treatment.
Similar to Boerhaaven syndrome, Mallory-Weiss syndrome also has tears in the esophageal tissue. Unlike Boerhaaven, Mallory-Weiss occurs at the junction of the esophagus and stomach, in the mucous membrane. Other similarities to Boerhaaven syndrome include a strong association between Mallory-Weiss and alcoholism. Mallory-Weiss is also associated with eating disorders. While Boerhaaven will result in death without proper care or surgical treatment, Mallory-Weiss is rarely fatal.
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