Differential Diagnosis for Epigastric Pain Worse After Eating

Single Most Likely Diagnosis

• Gastroesophageal Reflux Disease (GERD): This condition is characterized by the backflow of stomach acid into the esophagus, causing symptoms that can worsen after eating, especially after consuming large or heavy meals, citrus fruits, tomatoes, chocolate, spicy foods, or fatty foods.

Other Likely Diagnoses

• Peptic Ulcer Disease: Both gastric and duodenal ulcers can cause epigastric pain that worsens after eating. The pain is often described as burning or gnawing and can be temporarily relieved by eating or taking antacids in the case of duodenal ulcers.
• Functional Dyspepsia: Also known as non-ulcer dyspepsia or indigestion, this condition involves recurring signs and symptoms of indigestion that have no obvious cause. Symptoms can include pain or discomfort in the upper abdomen that may worsen after eating.
• Gallstones: While gallstones often cause right upper quadrant pain, they can sometimes cause epigastric pain, especially if the stones are obstructing the ampulla of Vater. Eating, particularly fatty foods, can trigger or worsen the pain.

Do Not Miss Diagnoses

• Myocardial Infarction: Although myocardial infarction typically presents with chest pain, it can occasionally manifest as epigastric pain, especially in women, diabetics, or the elderly. The pain may worsen with exertion or eating if it triggers an increase in cardiac workload.
• Pancreatitis: Acute pancreatitis can cause severe, persistent epigastric pain that radiates to the back and worsens after eating, especially fatty foods. Chronic pancreatitis can also cause similar pain, often accompanied by weight loss and steatorrhea.
• Gastric Cancer: Although less common, gastric cancer can present with epigastric pain that worsens after eating, along with weight loss, anorexia, and vomiting.

Rare Diagnoses

• Zollinger-Ellison Syndrome: A rare disorder characterized by excessive gastric acid secretion due to a gastrin-producing tumor, leading to severe peptic ulcers and diarrhea. The epigastric pain can worsen after eating due to the high acid production.
• Eosinophilic Gastroenteritis: A rare condition involving eosinophilic infiltration of the gastrointestinal tract, which can cause abdominal pain, nausea, vomiting, and diarrhea. The symptoms can worsen after eating certain foods.
• Celiac Disease: An autoimmune disorder where the ingestion of gluten leads to damage in the small intestine. It can cause abdominal pain, diarrhea, and malabsorption, and symptoms may worsen after consuming gluten-containing foods.