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They might start at half the standard initiation dose, using microdosing tirzepatide at 1.25mg for the first 2 weeks before moving to 2.5mg

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[3] described three dominant hypotheses of HH, which are as follows: (1) increased intra-abdominal pressure that moves the gastroesophageal junction into the thorax cavity, (2) esophageal shortening from innate causes or acquired caused by fibrosis, and (3) widening of the orifice from innate or acquired changes in the crural muscles or connective tissue of the diaphragm

10.1016/j.jss.2012.12.010 [DOI] [PubMed] [Google Scholar] Wang G.-J., Gao C.-F., Wei D., Wang C., Ding S.-Q