Differential Diagnosis for Epigastric Pain

The differential diagnosis for epigastric pain is broad and includes various conditions affecting the gastrointestinal, cardiovascular, and other systems. Here's a categorized list of potential diagnoses:

• Single Most Likely Diagnosis

  • Gastroesophageal reflux disease (GERD): This is often the most common cause of epigastric pain due to the retrograde flow of stomach contents into the esophagus, leading to inflammation and discomfort.

• Other Likely Diagnoses

  • Peptic ulcer disease (PUD): Including both gastric and duodenal ulcers, PUD is a common cause of epigastric pain, typically related to Helicobacter pylori infection or NSAID use.
  • Functional dyspepsia: A condition characterized by recurring signs and symptoms of indigestion that have no obvious cause, often related to stress, eating habits, or other non-organic factors.
  • Cholecystitis or cholelithiasis: Inflammation of the gallbladder or gallstones can cause epigastric pain, especially after eating fatty foods.
  • Pancreatitis: Inflammation of the pancreas, which can be acute or chronic, often presents with severe epigastric pain radiating to the back.

• Do Not Miss Diagnoses

  • Myocardial infarction (MI): Although chest pain is the hallmark of MI, epigastric pain can occasionally be the presenting symptom, especially in diabetic patients or those with atypical presentations.
  • Aortic dissection: A life-threatening condition where there is a tear in the aorta's inner layer, which can cause severe, tearing epigastric or back pain.
  • Esophageal rupture or perforation: A serious condition that requires immediate medical attention, presenting with severe chest or epigastric pain.
  • Gastric cancer: Although less common, gastric cancer can present with epigastric pain, weight loss, and other non-specific symptoms.

• Rare Diagnoses

  • Zollinger-Ellison syndrome: A rare disorder characterized by excessive gastric acid production due to a gastrin-secreting tumor, leading to severe peptic ulcers and epigastric pain.
  • Eosinophilic esophagitis: An inflammatory condition of the esophagus that can cause epigastric pain, dysphagia, and food impaction, often associated with atopic diseases.
  • Superior mesenteric artery syndrome: A rare condition where the duodenum is compressed between the abdominal aorta and the superior mesenteric artery, causing epigastric pain, nausea, and vomiting.

Each of these diagnoses has distinct features and risk factors that can guide the diagnostic process. A thorough history, physical examination, and appropriate diagnostic tests are essential for accurately diagnosing the cause of epigastric pain.