Differential Diagnosis for Epigastric Pain
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): This is often the most common cause of epigastric pain due to the reflux of stomach acid into the esophagus, leading to inflammation and pain.
- Peptic Ulcer Disease: Including both gastric and duodenal ulcers, this condition is a frequent cause of epigastric pain due to the erosion of the mucosal lining of the stomach or duodenum.
Other Likely Diagnoses
- Gastritis: Inflammation of the stomach lining can cause epigastric pain and is often associated with Helicobacter pylori infection, alcohol use, or nonsteroidal anti-inflammatory drug (NSAID) use.
- Functional Dyspepsia: A condition characterized by recurring signs and symptoms of indigestion that have no obvious cause, often related to eating or stress.
- Cholecystitis: Inflammation of the gallbladder, usually due to gallstones, can cause epigastric pain that may radiate to the right upper quadrant.
Do Not Miss Diagnoses
- Myocardial Infarction: Although the pain of a heart attack is typically described as chest pain, it can sometimes be felt in the epigastric region, especially in women or diabetic patients.
- Pancreatitis: Inflammation of the pancreas can cause severe epigastric pain radiating to the back, and missing this diagnosis can lead to serious complications.
- Aortic Dissection: A tear in the aorta's inner layer can cause severe, tearing chest or epigastric pain and is a medical emergency.
- Esophageal Rupture: A rare but life-threatening condition where the esophagus tears, often due to severe vomiting or an endoscopic procedure.
Rare Diagnoses
- Gastric Cancer: Although rare, especially in younger populations, gastric cancer can present with epigastric pain and should be considered in patients with risk factors or persistent symptoms.
- Pancreatic Cancer: Similar to gastric cancer, pancreatic cancer is rare but can cause epigastric pain, especially if the tumor involves the body or tail of the pancreas.
- Splenic Artery Aneurysm: A rare condition where an aneurysm forms in the splenic artery, potentially causing epigastric pain if it ruptures.
- Hernias: Hiatal hernias or other abdominal wall hernias can cause epigastric pain, especially if they become incarcerated or strangulated.