Differential Diagnosis

The patient's symptoms of nocturnal panic attacks, stomach discomfort, and acid reflux sensations can be attributed to various diagnoses. Here's a categorized differential diagnosis:

• Single most likely diagnosis
  • Gastroesophageal Reflux Disease (GERD): The patient's history of hiatal hernia, nocturnal acid reflux, and stomach discomfort suggests GERD as a likely diagnosis. The symptoms of rumbling stomach sounds and acid reflux are consistent with this condition.
• Other Likely diagnoses
  • Anxiety Disorder: The patient's experience of panic attacks, especially at night, and increased anxiety levels after a recent car accident, suggests an underlying anxiety disorder.
  • Functional Dyspepsia: The patient's symptoms of stomach discomfort, rumbling sounds, and previous response to a bland diet may indicate functional dyspepsia.
  • Sleep Disorder: The patient's poor sleep quality and nocturnal panic attacks could be related to an underlying sleep disorder, such as insomnia or sleep anxiety.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Cardiac Disease: Although the patient's symptoms are primarily gastrointestinal, it's essential to consider cardiac disease, such as myocardial infarction or angina, as a potential cause of chest pain or discomfort, especially given the patient's history of severe post-colonoscopy pain.
  • Peptic Ulcer Disease: The patient's history of stomach discomfort and acid reflux sensations warrants consideration of peptic ulcer disease, which can be a serious condition if left untreated.
  • Esophageal Cancer: Although rare, esophageal cancer can present with symptoms similar to GERD, such as dysphagia, odynophagia, or weight loss.
• Rare diagnoses
  • Gastroparesis: This condition, characterized by delayed gastric emptying, can cause symptoms similar to the patient's, such as stomach discomfort, nausea, and vomiting.
  • Eosinophilic Esophagitis: This rare condition, characterized by eosinophilic infiltration of the esophagus, can cause symptoms such as dysphagia, food impaction, and chest pain.
  • Cyclic Vomiting Syndrome: This rare condition, characterized by recurrent episodes of severe vomiting, can cause symptoms similar to the patient's, such as stomach discomfort and nausea.