Differential Diagnosis
- Single most likely diagnosis
- Gastroesophageal reflux disease (GERD): This is the most likely diagnosis given the symptoms of burning pain in the epigastric area ascending into the chest, especially after large meals and at night, combined with endoscopic findings of inflammation in the distal esophagus. These symptoms and findings are classic for GERD.
- Other Likely diagnoses
- Esophagitis due to other causes (e.g., infectious, pill-induced): While GERD is the most common cause of esophagitis, other forms of esophagitis could present similarly and should be considered, especially if the patient does not respond to typical GERD treatment.
- Dyspepsia: This condition, often referred to as indigestion or upset stomach, can cause similar symptoms and may need to be differentiated from GERD, though the endoscopic findings would lean more towards an inflammatory cause like GERD.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Esophageal cancer: Although less likely, given the patient's age and the presence of inflammation, esophageal cancer could present with similar symptoms and must be ruled out, especially if there are risk factors such as a history of smoking or alcohol use.
- Coronary artery disease (CAD) with cardiac ischemia: The chest pain described could also be indicative of cardiac ischemia, which is a medical emergency. It's crucial to differentiate cardiac from esophageal causes of chest pain.
- Rare diagnoses
- Eosinophilic esophagitis: This is a less common condition characterized by eosinophilic infiltration of the esophagus, often presenting with dysphagia and food impaction, but could also cause chronic inflammation and symptoms overlapping with GERD.
- Zollinger-Ellison syndrome: A rare disorder characterized by excessive gastric acid production due to a gastrin-secreting tumor, leading to severe peptic ulcer disease and esophagitis. The symptoms could mimic those of severe GERD, but the endoscopic findings and lack of response to standard GERD treatment might prompt further investigation.