What is the most common cause of Boerhaave syndrome?

• A. Forceful vomiting
• B. Esophageal spasm
• C. Gastric bypass surgery
• D. Foreign object ingestion

Answer: (A)

Boerhaave syndrome is characterized by a spontaneous rupture of the esophagus, and the most common cause of this condition is indeed forceful vomiting. The mechanism of injury typically occurs when excessive intrathoracic pressure is generated during vomiting, leading to a tear in the esophageal wall. This condition is more frequently seen in individuals experiencing severe bouts of retching or vomiting, particularly in the context of conditions such as bulimia or after heavy drinking.

Other potential causes, while possible, are significantly less common. Esophageal spasm can lead to discomfort or other complications, but it does not typically result in the rupture seen in Boerhaave syndrome. Gastric bypass surgery is associated with various complications but is not known as a typical cause of esophageal rupture. Similarly, ingestion of foreign objects can lead to esophageal injury but is not the most prevalent reason behind Boerhaave syndrome. Therefore, forceful vomiting stands out as the primary trigger due to its direct effect on esophageal integrity.