Gastroesophageal Reflux Disease (GERD) Differential Diagnosis

The differential diagnosis for GERD symptoms can be broad, encompassing various conditions that mimic its presentation. Here's a categorized approach to considering these diagnoses:

• Single Most Likely Diagnosis

  • Gastroesophageal Reflux Disease (GERD): This is the most likely diagnosis for symptoms such as heartburn, regurgitation, and dysphagia, especially if they are exacerbated by food, lying down, or certain activities. The pathophysiology involves the reflux of stomach contents into the esophagus, leading to irritation and inflammation.

• Other Likely Diagnoses

  • Peptic Ulcer Disease: Symptoms can overlap with GERD, including epigastric pain and dyspepsia. The presence of ulcers in the stomach or duodenum can cause similar discomfort.
  • Functional Dyspepsia: A condition characterized by recurring signs and symptoms of indigestion that have no obvious cause. Symptoms can mimic GERD but are more related to eating and may not respond to typical GERD treatments.
  • Esophageal Motility Disorders: Conditions like achalasia or diffuse esophageal spasm can cause dysphagia and chest pain, similar to GERD, but are related to abnormalities in esophageal muscle function.

• Do Not Miss Diagnoses

  • Acute Coronary Syndrome (ACS): Chest pain is a common symptom of both GERD and ACS. It's crucial to rule out cardiac causes, especially in patients with risk factors for coronary artery disease, as missing ACS can be fatal.
  • Esophageal Cancer: Although rare, esophageal cancer can present with progressive dysphagia and weight loss. Early detection is key to improving outcomes.
  • Pulmonary Embolism: Can cause sudden onset of chest pain and shortness of breath, which might be confused with severe GERD symptoms. Given its high mortality rate, it's essential to consider and rule out.

• Rare Diagnoses

  • Eosinophilic Esophagitis: An inflammatory condition of the esophagus that can cause dysphagia, food impaction, and heartburn, often in patients with atopic diseases.
  • Zollinger-Ellison Syndrome: A rare disorder characterized by excessive gastric acid production due to a gastrin-secreting tumor, leading to severe peptic ulcer disease and GERD-like symptoms.
  • Rumination Syndrome: A condition where food is regurgitated into the mouth without nausea or retching, often shortly after eating, which can be mistaken for GERD.