Differential Diagnosis
The patient's symptoms and test results suggest a complex gastrointestinal issue. Here's a categorized differential diagnosis:
- Single most likely diagnosis
- Gastroesophageal reflux disease (GERD): The patient's symptoms of heartburn, regurgitation, difficulty swallowing, and globus sensation are classic for GERD. The positive H. pylori test and initial improvement with treatment, followed by new symptoms, may indicate a complex interplay between GERD and H. pylori infection.
- Other Likely diagnoses
- Irritable bowel syndrome (IBS): The patient's bloating, nausea, cramps, and altered bowel habits could be indicative of IBS, which often coexists with GERD.
- H. pylori-related dyspepsia: Although the patient started feeling better with H. pylori treatment, the new symptoms of bloating, nausea, and cramps could be related to the infection or the treatment itself.
- Functional dyspepsia: The patient's symptoms of epigastric burning, tightness, and difficulty swallowing could be indicative of functional dyspepsia, a condition characterized by chronic or recurrent upper abdominal symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Esophageal cancer: Although rare in a 25-year-old, esophageal cancer can present with difficulty swallowing, regurgitation, and weight loss. It's essential to rule out this diagnosis, especially if symptoms persist or worsen.
- Gastric cancer: Similarly, gastric cancer can present with non-specific symptoms like bloating, nausea, and abdominal pain. H. pylori infection is a known risk factor for gastric cancer.
- Eosinophilic esophagitis: This condition can cause difficulty swallowing, food impaction, and chest pain, and can be triggered by food allergies or other factors.
- Rare diagnoses
- Gastroparesis: A condition characterized by delayed gastric emptying, which can cause nausea, vomiting, bloating, and abdominal pain.
- Celiac disease: An autoimmune disorder that can cause gastrointestinal symptoms, including bloating, abdominal pain, and diarrhea, in response to gluten ingestion.
- Inflammatory bowel disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause chronic gastrointestinal symptoms, including abdominal pain, diarrhea, and weight loss.
To rule out these diagnoses, further testing and evaluation may be necessary, including:
- Upper endoscopy to visualize the esophagus, stomach, and duodenum
- Biopsy to rule out esophageal or gastric cancer
- Breath test to assess for small intestine bacterial overgrowth (SIBO)
- Blood tests to evaluate for celiac disease or IBD
- Trial of proton pump inhibitors (PPIs) to assess for GERD
- Dietary modifications to assess for food intolerances or allergies