A previously healthy woman in her 50s restarted semaglutide ↗ at the maximum 2.4 mg weekly dose after several months off the drug, with no step-up. The next day she was in shock and on a ventilator with a torn esophagus. Doctors are calling it the first documented case of Boerhaave's syndrome, a full-thickness rupture of the esophagus, tied to a GLP-1 drug.
The case was published online June 12 in the Journal of Cardiothoracic Surgery ↗ by Jason Aubrey, Chance Benner, and Geoffrey Lam.
Semaglutide is the molecule sold as Ozempic and Wegovy. Like all GLP-1 receptor agonists, it slows how fast the stomach empties, which is part of how it curbs appetite and also why nausea and vomiting are its most common side effects. Doctors already knew the drug could cause tears in the lining of the esophagus, called Mallory-Weiss tears. What had not been reported before is a rupture through the entire wall.
Boerhaave's syndrome is what happens when violent vomiting drives pressure against a closed throat and the esophagus splits open. It is rare, it is a surgical emergency, and it kills a meaningful share of the people who get it even with treatment.
What happened to her
She came in with severe nausea, vomiting, and chest pain, then crashed into shock and respiratory failure that required a breathing tube. Imaging showed air in the chest cavity and fluid around both lungs. A swallow study confirmed the esophagus had perforated. The first round of treatment was an endoscopic stent to bridge the hole, a feeding tube threaded past it, and a chest drain.
She got better and went home, then came back two months later with a necrotizing pneumonia, an infection eating into lung tissue. The hole had opened a fistula between her esophagus and the space around her lung, an abscess had formed, and the stent had slipped out of place. Surgeons opened her chest, drained the abscess, cut out the dead lung, and patched the perforation with a flap of muscle from between her ribs. At her ten-month check she was eating normally, the esophagus had healed, and she was told to stay off GLP-1 drugs for good.
The lesson is the dosing, not the drug
One case does not prove the drug caused the rupture, and the authors do not claim it does. Millions of people take semaglutide without their esophagus tearing. What makes this worth reading is the specific setup. She restarted at the highest dose after a long gap, skipping the slow titration that the label calls for precisely because the gut needs time to tolerate the slowed emptying. The standard schedule climbs from 0.25 mg over months. She went straight to 2.4 mg.
That pattern is common in the real world. People pause these drugs for cost, supply, or a break, then want to pick up where they left off. This report is a flag that restarting is not the same as continuing, and that the re-titration step is not optional paperwork.
It sits next to a separate signal the section covered this month. Delayed gastric emptying is also why GLP-1 patients showed roughly triple the odds of aspiration pneumonia ↗ after an emergency stroke procedure. The same slowed stomach that makes the drugs work is the same mechanism behind their worst rare complications, and a full stomach forced upward is the thread connecting both.