Differential Diagnosis for Dysphagia, Long Standing GORD, and Chest Pain

The patient's symptoms of dysphagia, long standing Gastroesophageal Reflux Disease (GORD), and chest pain with a heavy sensation that are relieved after eructation and belching can be approached by considering the following differential diagnoses:

• Single Most Likely Diagnosis

  • D. Sliding hiatal hernia: This condition is closely associated with GORD and can cause symptoms of dysphagia and chest pain due to the herniation of the stomach into the thorax, which can lead to reflux and mechanical obstruction. The relief of symptoms after eructation and belching is consistent with the reduction of pressure and temporary alleviation of the hernia's effects.

• Other Likely Diagnoses

  • A. Barrett’s oesophagus: A complication of long-standing GORD, Barrett's esophagus can lead to dysphagia and chest pain, although the direct relationship with relief after belching is less clear. It's a condition that arises from chronic acid exposure, leading to metaplastic changes in the esophageal lining.
  • C. Achalasia: This motility disorder of the esophagus can cause dysphagia and chest pain. While achalasia typically presents with progressive dysphagia to both liquids and solids, the relief of symptoms after eructation and belching might not be as directly related, but it could be considered due to the potential for intermittent relief with air swallowing and subsequent belching.

• Do Not Miss Diagnoses

  • B. Gastric volvulus: Although less common, gastric volvulus can present with acute or intermittent symptoms of dysphagia, chest pain, and can be associated with GORD. It's a condition where the stomach abnormally rotates, potentially leading to obstruction and ischemia, making it critical not to miss due to its potential for severe complications.

• Rare Diagnoses

  • Other rare conditions such as esophageal spasm, diffuse esophageal spasm, or nutcracker esophagus could potentially cause chest pain and dysphagia but are less directly linked to long-standing GORD and the specific pattern of relief after eructation and belching described in the scenario. These conditions involve abnormal esophageal contractions and can cause chest pain and difficulty swallowing.