Differential Diagnosis for JW
- Single most likely diagnosis
- Irritable Bowel Syndrome (IBS): JW's symptoms of abdominal pain, diarrhea, and bloating, along with the absence of other alarming features such as blood in the stool, and the exacerbation of symptoms with stress, are consistent with IBS. Her fear of eating due to anticipated pain and the improvement with omeprazole also align with IBS, especially given her history of GERD.
- Other Likely diagnoses
- Functional Dyspepsia: The episodic stomach pain, occasional stinging pain, and some relief with omeprazole suggest functional dyspepsia, which often coexists with IBS.
- Small Intestine Bacterial Overgrowth (SIBO): JW's symptoms of bloating, abdominal pain, and diarrhea could be indicative of SIBO, especially given her history of restriction eating disorder and use of probiotics, which might influence gut flora.
- Inflammatory Bowel Disease (IBD): Although less likely given the absence of blood in the stool and the normal CT scan, IBD (Crohn's disease or ulcerative colitis) remains a consideration due to the chronic nature of JW's symptoms and the presence of diarrhea.
- Do Not Miss diagnoses
- Celiac Disease: Despite being vegan, JW could still be exposed to gluten, and celiac disease can present with similar gastrointestinal symptoms. It's crucial to rule out celiac disease due to its potential for long-term complications if left untreated.
- Gastric or Duodenal Ulcer: The use of omeprazole and the presence of episodic stomach pain raise the possibility of a gastric or duodenal ulcer, which could be exacerbated by stress.
- Pancreatitis: Although JW's symptoms do not strongly suggest pancreatitis, the occasional severe abdominal pain and the fact that she stays in bed due to pain warrant consideration of this diagnosis, especially if her symptoms worsen.
- Rare diagnoses
- Eosinophilic Gastroenteritis: This rare condition involves eosinophilic infiltration of the gastrointestinal tract and can present with abdominal pain, diarrhea, and bloating. It's more likely in individuals with a history of atopic diseases or food allergies.
- Mast Cell Activation Syndrome: Given JW's history of restriction eating disorder and her sensitivity to various foods (lactose intolerance), mast cell activation syndrome could be considered, especially if she experiences other systemic symptoms such as flushing or hives.
- Chronic Intestinal Pseudo-obstruction: This rare condition involves recurrent episodes of abdominal pain, bloating, and alterations in bowel habits without any mechanical obstruction. It could be considered if JW's symptoms persist and other diagnoses are ruled out.