Differential Diagnosis for Epigastric Pain and Dyspepsia
- Single Most Likely Diagnosis
- Peptic Ulcer Disease (PUD): The patient's symptoms of dyspepsia and epigastric pain that are relieved by antacids and worsen with hunger are classic for PUD. The intermittent nature of the symptoms over the last year also supports this diagnosis.
- Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): Although the symptoms can be similar to PUD, GERD typically presents with a burning sensation in the chest and regurgitation, which are not mentioned. However, some patients with GERD can present with epigastric pain.
- Functional Dyspepsia: This is a diagnosis of exclusion, where other causes of dyspepsia have been ruled out. The patient's symptoms could fit this diagnosis, but given the response to antacids and the worsening of pain with hunger, PUD is more likely.
- Do Not Miss Diagnoses
- Gastric Cancer: Although rare in a 35-year-old, gastric cancer can present with nonspecific symptoms of dyspepsia and epigastric pain. It is crucial to not miss this diagnosis due to its severe consequences.
- Pancreatitis: Acute or chronic pancreatitis can cause epigastric pain that radiates to the back. While the patient's symptoms do not strongly suggest pancreatitis, it is a diagnosis that should be considered due to its potential severity.
- Rare Diagnoses
- Zollinger-Ellison Syndrome: A rare condition characterized by excessive gastric acid production due to a gastrinoma. The symptoms can be similar to PUD, but it is much less common.
- Gastric Volvulus: A rare condition where the stomach twists abnormally, causing epigastric pain and dyspepsia. The patient's symptoms do not strongly suggest this diagnosis, but it should be considered in the differential.