Differential Diagnosis for Recurrent Heartburn and Bitter Taste
- Single most likely diagnosis
- Gastroesophageal Reflux Disease (GERD): The patient's symptoms of recurrent heartburn that worsens at night when lying down and a bitter taste in the mouth when lifting weights are classic for GERD. This condition is characterized by the reflux of stomach acid into the esophagus, causing symptoms like heartburn and regurgitation.
- Other Likely diagnoses
- Esophagitis: This is an inflammation of the esophagus, often caused by acid reflux, which could explain the patient's heartburn. The bitter taste could be due to refluxed stomach contents.
- Gastritis: Inflammation of the stomach lining, which could lead to symptoms like heartburn and a bitter taste, especially if associated with reflux.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Boerhaave syndrome: Although rare and less likely given the chronic nature of the symptoms, Boerhaave syndrome (spontaneous rupture of the esophagus) is a medical emergency that could present with severe chest pain and potentially vomiting or regurgitation of food. It's crucial to consider in cases of severe or acute presentations.
- Rare diagnoses
- 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 symptoms.
- Eosinophilic esophagitis: A chronic immune system disease in which a type of white blood cell, the eosinophil, builds up in the esophagus in response to an allergen or irritant, leading to difficulty swallowing and food impaction, though heartburn can also be a symptom.
Each of these diagnoses should be considered based on the patient's specific presentation, medical history, and further diagnostic testing as necessary.