What is the most likely diagnosis for a 36-year-old woman presenting with intermittent chest burning sensation, worsened by eating, accompanied by a sensation of a lump in her throat, weight loss, and nausea, with a history of seasonal allergies, two uncomplicated cesarean sections (C-sections), and a 9 pack-year history of cigarette smoking?

Differential Diagnosis

The patient presents with an intermittent burning sensation in her chest, worsened by eating, and accompanied by a feeling of a lump in her throat, weight loss, and occasional nausea. Based on these symptoms, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis

  • E. gastrosophageal reflux disease (GERD): The symptoms of intermittent burning sensation in the chest, worsened by eating, and a feeling of a lump in the throat are classic for GERD. The patient's history of a protuberant abdomen and being overweight (BMI 27 kg/m^2) also increases the likelihood of GERD.

• Other Likely Diagnoses

  • D. esophageal spasm: This condition can cause chest pain and a feeling of a lump in the throat, similar to the patient's symptoms. However, it is less likely than GERD given the lack of specific triggers or patterns to the pain.
  • F. Helicobacter pylori infection: Although this infection is more commonly associated with peptic ulcer disease, it can also cause GERD-like symptoms. The patient's weight loss and nausea could be indicative of a more serious infection.
  • C. esophageal diverticulum: This condition can cause dysphagia, regurgitation, and chest pain, but it is less common and typically presents with more severe symptoms.

• Do Not Miss Diagnoses

  • B. esophageal cancer: Although the patient is relatively young, esophageal cancer can present with nonspecific symptoms such as weight loss, nausea, and chest pain. It is essential to consider this diagnosis, especially given the patient's smoking history.
  • A. cholelithiasis: Gallstones can cause referred pain to the chest and worsen after eating, especially fatty foods. Although less likely, it is crucial to rule out this diagnosis, especially if the patient's symptoms worsen or change.

• Rare Diagnoses

  • Other rare conditions such as esophageal rings, eosinophilic esophagitis, or motility disorders (e.g., achalasia) could also be considered, but they are less likely given the patient's presentation and lack of specific symptoms.