Differential Diagnosis for Chronic Stomach Pain and Presyncope
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): This condition is a common cause of chronic stomach pain and can lead to presyncope due to discomfort or pain that may trigger a vagal response, leading to a drop in blood pressure.
Other Likely Diagnoses
- Peptic Ulcer Disease: Chronic stomach pain is a hallmark of peptic ulcers, and significant bleeding from an ulcer can lead to hypovolemic shock, presenting with presyncope.
- Gastroparesis: This condition, characterized by delayed gastric emptying, can cause chronic stomach pain, nausea, and vomiting, potentially leading to dehydration and electrolyte imbalances that may cause presyncope.
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause chronic abdominal pain and may lead to presyncope through dehydration, anemia, or electrolyte imbalances.
Do Not Miss Diagnoses
- Mesenteric Ischemia: Although less common, this condition is critical to diagnose early because it can lead to bowel infarction. Chronic mesenteric ischemia can cause abdominal pain after eating (postprandial pain) and may lead to weight loss and presyncope due to fear of eating.
- Abdominal Aortic Aneurysm: A leaking or ruptured abdominal aortic aneurysm can cause severe abdominal pain and presyncope due to hypovolemic shock. It's a medical emergency that requires immediate attention.
- Pheochromocytoma: This rare tumor of the adrenal gland can cause episodic hypertension, which may lead to presyncope. Abdominal pain can occur if the tumor arises from an extra-adrenal site within the abdomen.
Rare Diagnoses
- Eosinophilic Gastroenteritis: A rare condition characterized by eosinophilic infiltration of the gastrointestinal tract, leading to chronic abdominal pain, and potentially causing presyncope through mechanisms like intestinal obstruction or severe inflammation.
- Chronic Intestinal Pseudo-Obstruction: A rare disorder of the intestinal motility that can cause chronic abdominal pain, nausea, vomiting, and may lead to presyncope due to malnutrition, dehydration, or electrolyte imbalances.
- Neuroendocrine Tumors: Certain neuroendocrine tumors, like carcinoids, can produce substances that lead to flushing, diarrhea, wheezing, and heart valve abnormalities, potentially causing presyncope. Abdominal pain can be a symptom if the tumor arises within the abdomen.