Differential Diagnosis for New Onset Belching in a 64-Year-Old Woman

Single Most Likely Diagnosis

• Functional Dyspepsia: This is a common condition characterized by upper abdominal symptoms, including belching, without an identifiable cause. It's often related to eating or stress and is a frequent diagnosis in patients presenting with belching without a history of GERD.

Other Likely Diagnoses

• Gastroparesis: A condition where the stomach takes too long to empty its contents, which can lead to belching, nausea, and vomiting. It's more common in older adults and those with diabetes.
• Irritable Bowel Syndrome (IBS): Although primarily known for altering bowel habits, some patients with IBS may experience belching due to swallowed air or gas production in the intestines.
• Small Intestine Bacterial Overgrowth (SIBO): An overgrowth of bacteria in the small intestine can lead to gas production, causing bloating, abdominal pain, and belching.

Do Not Miss Diagnoses

• Gastric Cancer: Although rare, new onset of symptoms like belching in an older adult could be an early sign of gastric cancer. It's crucial to investigate further if other alarming symptoms are present, such as weight loss or difficulty swallowing.
• Peptic Ulcer Disease: Ulcers in the stomach or duodenum can cause belching, among other symptoms like abdominal pain. It's essential to consider this diagnosis, especially if the patient is taking NSAIDs or has a history of Helicobacter pylori infection.
• Cardiac Ischemia: In some cases, belching can be associated with cardiac conditions, as the heart and stomach share nerve pathways. It's crucial to rule out cardiac ischemia, especially if the patient has risk factors for heart disease.

Rare Diagnoses

• Rumination Syndrome: A condition where food is regurgitated into the mouth, often accompanied by belching, without the forceful vomiting seen in GERD. It's more common in individuals with intellectual disabilities but can occur in anyone.
• Eosinophilic Esophagitis: An inflammatory condition of the esophagus that can cause difficulty swallowing, food impaction, and sometimes belching, though it's less common.
• Gastric Bezoar: A mass of food or other material that accumulates in the stomach and fails to pass through the digestive system, which can cause belching, nausea, and vomiting.