Differential Diagnosis for Gastric Pain in an 8-year-old Asian Male

Single Most Likely Diagnosis

• Gastroesophageal Reflux Disease (GERD): This condition is common in children and can cause gastric pain that worsens after eating, especially if the child lies down after meals. Nighttime waking due to pain is also consistent with GERD.

Other Likely Diagnoses

• Peptic Ulcer Disease: Can cause epigastric pain that worsens with food intake and improves with antacids or food. Nighttime pain is a classic symptom.
• Functional Dyspepsia: A common cause of chronic abdominal pain in children, often related to eating and can disrupt sleep.
• Helicobacter pylori Infection: Common in Asian populations and can cause peptic ulcers and gastritis, leading to abdominal pain.

Do Not Miss Diagnoses

• Appendicitis: Although less common with these specific symptoms, appendicitis can present atypically in children and is a surgical emergency.
• Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause chronic abdominal pain, weight loss, and nocturnal symptoms.
• Gastric Cancer: Extremely rare in children but would be catastrophic if missed. Unusual or persistent symptoms warrant further investigation.

Rare Diagnoses

• Eosinophilic Gastroenteritis: A rare condition characterized by eosinophilic infiltration of the gastrointestinal tract, which can cause abdominal pain and gastrointestinal symptoms.
• Gastric Volvulus: A rare condition where the stomach twists abnormally, which can cause severe abdominal pain and vomiting.
• Congenital Anomalies: Such as pyloric stenosis or gastric duplications, which are rare and usually present in infancy but can occasionally be diagnosed later in childhood.

Tests to Confirm Diagnosis

• Upper Endoscopy: To visualize the esophagus, stomach, and duodenum for ulcers, inflammation, or other abnormalities.
• Barium Swallow or Upper GI Series: To evaluate the upper gastrointestinal tract for structural abnormalities.
• Helicobacter pylori Testing: Breath test, stool antigen test, or blood test to detect H. pylori infection.
• Complete Blood Count (CBC) and Blood Chemistry Tests: To look for signs of infection, inflammation, or other systemic conditions.
• Imaging Studies (Ultrasound, CT, or MRI): To evaluate for appendicitis, IBD, or other structural abnormalities.
• pH Monitoring: To diagnose GERD.
• Stool Tests: For occult blood or to rule out infectious causes.
• Biopsy: During endoscopy to diagnose conditions like eosinophilic gastroenteritis or to rule out malignancy.