Chest pain after a full stomach is a major manifestation of spontaneous esophageal rupture. Spontaneous esophageal rupture refers to a sudden increase in pressure in the lumen of the esophagus due to various causes, resulting in a full longitudinal tear of the left wall of the esophagus adjacent to the diaphragm. It is also known as Boerhaave’s syndrome, spontaneous esophageal tear syndrome, pressure rupture of the esophagus, peptic perforation of the esophagus, and non-traumatic esophageal perforation. Most of them occur after drinking alcohol or vomiting. So, how to differentially diagnose chest pain after satiety? The following is the differential diagnosis of chest pain after satiety: 1. Chest pain during swallowing: chest pain caused by esophagitis, esophageal hiatal hernia, diffuse esophageal spasm and esophageal tumor often attacks or intensifies during swallowing. 2, cardiogenic chest pain: when mentioning cardiogenic chest pain, people tend to think of coronary angina, or even myocardial infarction, which middle-aged and elderly people are prone to suffer from. In fact, cardiogenic chest pain is not always caused by coronary heart disease. At present, with the accelerated pace of life and work, many teenagers will often occur cardiogenic chest pain. 3, smoking chest pain: 20 to 30 years old lean and tall young men are the main prevalent group of spontaneous pneumothorax, most of the patients have a family tendency and smoking habits. According to statistical data, the incidence rate of smokers is nine to eleven times higher than that of nonsmokers. Patients may experience chest pain, chest tightness, and shortness of breath, with chest pain being the most common manifestation. Because of their youth and tall, thin bodies, patients often do not think of it and neglect the importance of medical examination. Symptoms and signs 1. Initial symptoms: vomiting, nausea, epigastric pain, chest pain. 1/3 to 1/2 patients have vomiting blood. Patients who vomit often have a history of alcohol consumption or overeating. The location of the pain is mostly in the upper abdomen, but can also be behind the sternum, in the two quarter ribs, in the lower chest, and sometimes radiates to the back of the shoulder. When the symptoms are severe, there may be shortness of breath, dyspnea, cyanosis, shock, etc. 2.Physical examination: it mostly shows acute abdomen, and there can be corresponding signs of liquid pneumothorax, epigastric pressure pain, muscle tension, and even platysma. Esophageal and gastric contents into the thoracic and peritoneal cavity can cause chemical thoracic and peritonitis, and there can be manifestations of acute septic mediastinitis and thoracic and peritonitis. The main clinical manifestations of spontaneous esophageal rupture are chest pain and upper gastrointestinal bleeding. The different types of manifestations are as follows: (1) Interstitial esophageal perforation is usually seen in elderly women, and commonly presents with severe pain behind the posterior subxiphoid and upper abdomen, which quickly radiates to the back, with a small amount of vomiting blood and low fever, without mediastinal emphysema and subcutaneous emphysema. (2) MalloryWeiss syndrome is prevalent in adult males aged 40-60 years. Most of the patients have binge drinking or long-term drinking habits, and it can also occur due to regular aspirin use. Patients complain of vomiting blood, often with fresh blood, immediately after heavy vomiting and dry vomiting. Only a small percentage of patients have chest pain. (3) Boerhaaave syndrome is also seen in middle-aged men. The typical history is severe nausea and vomiting after a large diet. In the case of lower esophageal perforation, there is severe lower chest and subxiphoid pain, and there may be radiating pain in the back and scapula. Some patients have only epigastric pain with shortness of breath, dyspnea or shock. Hypotension, increased heart rate and respiratory rate may occur. Gas spills through the ruptured esophagus to form a mediastinal emphysema, which in turn bleeds into a suprasternal and subcutaneous chest wall emphysema. On auscultation, pleural or pleural pericardial friction sounds can be heard, which are signs of pleural effusion or liquid pneumothorax. There are signs of epigastric pressure pain and decreased or absent bowel sounds.