Differential Diagnosis for Epigastric Pain with Nausea and Vomiting
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): This condition is characterized by the backflow of stomach acid into the esophagus, causing epigastric pain, nausea, and vomiting. It is a common condition that can be exacerbated by certain foods, obesity, and other factors.
Other Likely Diagnoses
- Peptic Ulcer Disease: This includes both gastric and duodenal ulcers, which can cause epigastric pain, nausea, and vomiting. The pain is often described as burning or gnawing and can be relieved by eating or taking antacids.
- Gastritis: Inflammation of the stomach lining can cause epigastric pain, nausea, and vomiting. It can be acute or chronic and is often associated with Helicobacter pylori infection or the use of nonsteroidal anti-inflammatory drugs (NSAIDs).
- Food Poisoning: Consuming contaminated food can lead to epigastric pain, nausea, and vomiting. The symptoms are usually acute and self-limiting but can be severe in certain cases.
Do Not Miss Diagnoses
- Myocardial Infarction: Although the classic symptom of a heart attack is chest pain, some patients, especially women and diabetics, may present with epigastric pain, nausea, and vomiting. Missing this diagnosis can be fatal.
- Pancreatitis: Inflammation of the pancreas can cause severe epigastric pain that radiates to the back, nausea, and vomiting. It requires prompt medical attention to prevent complications.
- Cholecystitis: Inflammation of the gallbladder can cause right upper quadrant pain that may radiate to the epigastrium, nausea, and vomiting. It can lead to serious complications if not treated promptly.
Rare Diagnoses
- Zollinger-Ellison Syndrome: A rare condition characterized by excessive gastric acid production due to a gastrin-producing tumor, leading to severe peptic ulcers, epigastric pain, nausea, and vomiting.
- Eosinophilic Gastroenteritis: A rare condition characterized by eosinophilic infiltration of the gastrointestinal tract, leading to epigastric pain, nausea, vomiting, and other gastrointestinal symptoms.
- Gastric Cancer: Although rare, gastric cancer can present with epigastric pain, nausea, and vomiting, especially in older adults or those with a family history of the disease.