Differential Diagnosis for Pain on Food Intake in an 11-Year-Old Boy

Single Most Likely Diagnosis

• Gastroesophageal Reflux Disease (GERD): This condition is common in children and can cause pain or discomfort when eating due to stomach acid flowing back into the esophagus.

Other Likely Diagnoses

• Functional Dyspepsia: A common condition characterized by recurring pain or discomfort in the upper abdomen, often related to eating.
• Constipation: Can cause abdominal pain that may worsen with eating due to increased bowel movement pressure.
• Food Allergies or Intolerances: Such as lactose intolerance, can lead to abdominal pain after consuming specific foods.
• Gastritis: Inflammation of the stomach lining, which can be caused by infection, medications, or other factors, leading to pain after eating.

Do Not Miss Diagnoses

• Appendicitis: Although less common in this presentation, appendicitis can cause abdominal pain that worsens with eating, especially if the appendix is located near the stomach or intestines.
• Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause chronic abdominal pain, diarrhea, and weight loss, and are crucial not to miss due to their significant impact on quality of life and potential complications.
• Pyloric Stenosis: A condition where the pylorus (the passage between the stomach and small intestine) narrows, causing severe vomiting and abdominal pain after eating, more common in infants but can occur in older children.
• Esophageal Foreign Body: Especially in children who might ingest non-food items, which can get stuck in the esophagus and cause severe pain upon attempting to eat or drink.

Rare Diagnoses

• 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 pain with eating.
• Celiac Disease: An autoimmune disorder where the ingestion of gluten leads to damage in the small intestine, causing abdominal pain, diarrhea, and malabsorption.
• Gastric Volvulus: A rare condition where the stomach twists abnormally, which can cause severe abdominal pain, especially after eating.
• Pancreatitis: Inflammation of the pancreas, which can cause severe abdominal pain that radiates to the back and worsens after eating, especially fatty foods.