Differential Diagnosis for a 5-year-old with Epigastric Pain Episodes at Night
- Single most likely diagnosis:
- Peptic ulcer disease: This condition is a common cause of epigastric pain, especially when it occurs at night. The pain can be related to the emptying of the stomach and the increased acidity during nighttime.
- Other Likely diagnoses:
- Gastroesophageal reflux disease (GERD): GERD can cause epigastric pain that worsens at night due to the reflux of stomach acid into the esophagus when the child is in a recumbent position.
- Functional dyspepsia: This is a common condition in children characterized by recurrent epigastric pain or discomfort not exclusively related to defecation, which could be worse at night.
- Helicobacter pylori infection: This bacterial infection can cause peptic ulcers and gastritis, leading to epigastric pain, especially at night.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Acute appendicitis: Although appendicitis typically presents with right lower quadrant pain, it can initially cause epigastric pain that may worsen at night. Missing this diagnosis can lead to perforation and severe complications.
- Intussusception: This condition involves the telescoping of one portion of the intestine into another, which can cause severe abdominal pain, including epigastric pain at night. It's a medical emergency that requires prompt diagnosis and treatment.
- Pancreatitis: Inflammation of the pancreas can cause severe epigastric pain that radiates to the back and worsens at night. It's crucial to diagnose and manage pancreatitis promptly to prevent complications.
- Rare diagnoses:
- Gastric volvulus: A rare condition where the stomach twists abnormally, which can cause severe epigastric pain, especially at night.
- Eosinophilic gastroenteritis: A rare inflammatory condition of the stomach and intestines that can cause abdominal pain, including epigastric pain at night, among other symptoms.
- Abdominal migraine: A condition that can cause recurrent episodes of abdominal pain, including epigastric pain, which may be worse at night, often accompanied by other migraine-like symptoms.