Differential Diagnosis for Difficulty with Food Digestion or Swallowing

Single Most Likely Diagnosis

• Gastroesophageal Reflux Disease (GERD): This condition is characterized by the backflow of stomach acid into the esophagus, leading to symptoms such as difficulty swallowing, feeling like food is stuck in the throat, and a sensation that food does not digest properly. The prevalence and common presentation of GERD make it a likely initial consideration.

Other Likely Diagnoses

• Dysphagia: This refers to difficulty swallowing, which can be due to various causes including esophageal strictures, esophagitis, or motility disorders like achalasia. Symptoms can include feeling like food is not passing into the stomach.
• Functional Dyspepsia: Also known as non-ulcer stomach pain or indigestion, this condition involves recurring signs and symptoms of indigestion that have no obvious cause. Patients may complain of food not digesting properly.
• Irritable Bowel Syndrome (IBS): While primarily associated with abdominal pain and changes in bowel movements, some patients with IBS may experience dyspepsia or feel like food is not digesting properly.

Do Not Miss Diagnoses

• Esophageal Cancer: Although less common, esophageal cancer can present with progressive dysphagia (difficulty swallowing) and should be considered, especially in older adults or those with risk factors like long-standing GERD.
• Achalasia: A motility disorder of the esophagus that makes swallowing difficult, leading to food accumulation in the esophagus. It's crucial to diagnose and treat to prevent complications like aspiration pneumonia.
• Eosinophilic Esophagitis: An inflammatory condition that can cause difficulty swallowing due to esophageal narrowing or spasms. It's more common in patients with atopic diseases like asthma or eczema.

Rare Diagnoses

• Scleroderma: A chronic autoimmune disease that can affect the esophagus, leading to dysphagia and dyspepsia due to esophageal fibrosis and decreased motility.
• Gastroparesis: A condition where the stomach takes too long to empty its contents, which can lead to feelings of food not digesting properly. It's often associated with diabetes but can have other causes.
• Rumination Syndrome: A condition where food is regurgitated back up into the mouth without nausea or vomiting, often shortly after eating. It can be mistaken for other disorders and requires specific management.