Differential Diagnosis

The patient's presentation of gastrointestinal issues, neck and arm pain, and a history of asthma, among other conditions, suggests a complex clinical picture. The differential diagnosis can be organized into the following categories:

• Single Most Likely Diagnosis

  • Gastroesophageal reflux disease (GERD): The patient's symptoms of heartburn, chest pain relieved by burping, and gas and bloating after meals, particularly with raw vegetables and dairy, are classic for GERD. The presence of a dairy allergy further supports this diagnosis, as dairy can exacerbate GERD symptoms.

• Other Likely Diagnoses

  • Irritable bowel syndrome (IBS): The patient's symptoms of gas, bloating, and regular bowel movements could also be consistent with IBS, especially given the trigger of certain foods like raw vegetables and dairy.
  • Cervical radiculopathy or strain: The patient's neck and arm pain, described as a straight line rather than a localized area, could be indicative of a cervical spine issue, such as a radiculopathy or strain, which could cause referred pain and tingling or numbness down the arm.
  • Allergic reactions or intolerances: Given the patient's known dairy allergy and symptoms worsening with dairy and raw vegetables, other allergic reactions or intolerances (e.g., to specific vegetables) could be contributing to the gastrointestinal symptoms.

• Do Not Miss Diagnoses

  • Coronary artery disease or myocardial infarction: Although the patient's chest pain is relieved by burping, which suggests a gastrointestinal cause, it is crucial not to miss cardiac causes of chest pain, especially given the family history of cardiac issues (sister with SVT).
  • Pulmonary embolism: The patient's recent difficulty with asthma due to Canadian wildfire smoke and allergies could potentially mask symptoms of a pulmonary embolism, which is a life-threatening condition.
  • Thyroid or parathyroid disorders: A lump in the neck vein could be indicative of a thyroid or parathyroid issue, which could have systemic effects, including on the gastrointestinal and cardiovascular systems.

• Rare Diagnoses

  • Eosinophilic esophagitis: This is a rare condition characterized by inflammation of the esophagus due to an allergic reaction, which could cause symptoms similar to GERD, especially with dysphagia and food impaction, though these are not mentioned.
  • Superior vena cava syndrome: The lump in the neck vein could, in rare cases, be associated with superior vena cava syndrome, which is a medical emergency caused by obstruction of the superior vena cava.