Differential Diagnosis for Epigastric Pain Worse with Lying Down

• Single Most Likely Diagnosis

  • Gastroesophageal Reflux Disease (GERD): This condition is characterized by the reflux of stomach acid into the esophagus, which can cause epigastric pain that worsens when lying down due to increased pressure on the lower esophageal sphincter.

• Other Likely Diagnoses

  • Peptic Ulcer Disease: Ulcers in the stomach or duodenum can cause epigastric pain that may worsen with lying down, especially if the ulcer is located near the gastroesophageal junction.
  • Functional Dyspepsia: This condition involves recurring signs and symptoms of indigestion that have no obvious cause, and symptoms can sometimes worsen with positional changes.

• Do Not Miss Diagnoses

  • Acute Coronary Syndrome (ACS): Although less common, epigastric pain can be a presentation of ACS, especially in women or diabetic patients. The pain may worsen with lying down due to increased demand on the heart.
  • Esophageal Rupture or Perforation: A severe and life-threatening condition that requires immediate medical attention. Pain can be exacerbated by movement or positional changes.
  • Pancreatitis: Inflammation of the pancreas can cause severe epigastric pain that radiates to the back and may worsen with lying down.

• Rare Diagnoses

  • Gastric Cancer: Although rare, gastric cancer can present with epigastric pain that worsens over time and may have positional components due to tumor size and location.
  • Esophageal Cancer: Similar to gastric cancer, esophageal cancer can cause progressive dysphagia and epigastric pain, which might worsen with lying down due to tumor obstruction or invasion into surrounding structures.
  • Cholecystitis or Biliary Colic: While more commonly associated with right upper quadrant pain, inflammation of the gallbladder or biliary colic can occasionally present with epigastric pain that worsens with certain positions.