Differential Diagnosis for an 11-year-old Patient with Throat Discomfort and Burping

Single Most Likely Diagnosis

• Gastroesophageal Reflux Disease (GERD): This condition is characterized by the backflow of stomach acid into the esophagus, which can cause a sensation of something being stuck in the throat, especially after eating. The symptoms worsening at night and the presence of burping support this diagnosis, as lying down can exacerbate reflux.

Other Likely Diagnoses

• Functional Dysphagia: This condition involves difficulty swallowing without an apparent physical obstruction. It could be related to the sensation of something being stuck, especially if the patient is experiencing anxiety or stress related to eating.
• Aerophagia: Swallowing air, often due to eating too quickly, drinking carbonated beverages, or chewing gum, can lead to burping and discomfort that might be perceived as something stuck in the throat.
• Eosinophilic Esophagitis: An allergic inflammatory condition of the esophagus that can cause difficulty swallowing and a sensation of food getting stuck, though it's less likely to be primarily associated with nighttime symptoms and burping.

Do Not Miss Diagnoses

• Esophageal Foreign Body: Although less common in an 11-year-old without a history of attempting to swallow non-food items, it's crucial to consider, especially if the onset was sudden. The presence of a foreign body could indeed cause a sensation of something being stuck and should be urgently evaluated.
• Food Allergy or Intolerance: Certain food allergies or intolerances could lead to esophageal irritation or spasm, causing the sensation of something being stuck. While less directly linked to nighttime symptoms, it's essential to consider given the potential for severe reactions.

Rare Diagnoses

• Esophageal Stricture: A narrowing of the esophagus, which could be congenital or acquired, leading to difficulty swallowing. However, this would likely cause more consistent symptoms rather than those limited to nighttime.
• Schatzki Ring: A narrow ring of tissue that can cause intermittent dysphagia, typically to solid foods. It's a rare condition and might not fully explain the burping and nighttime pattern of symptoms.
• Esophageal Spasm: Abnormal muscle contractions of the esophagus can cause chest pain and difficulty swallowing, but this diagnosis is less common in children and might not directly relate to the symptoms described.