Differential Diagnosis for Dyspepsia in a 14-Year-Old Girl

Single Most Likely Diagnosis

• Gastroesophageal Reflux Disease (GERD): This condition is characterized by the backflow of stomach acid into the esophagus, causing symptoms such as heartburn, throat burning, and upper abdominal discomfort. The symptoms described by the patient, including throat burning and upper abdominal burning, are classic for GERD, especially in the context of dyspepsia.

Other Likely Diagnoses

• Functional Dyspepsia: This is a common condition in adolescents, characterized by recurring upper abdominal pain or discomfort not exclusively related to bowel movements, and without an identifiable cause. The patient's symptoms could fit this diagnosis if no other cause is found.
• Helicobacter pylori Infection: Although less common in adolescents, H. pylori infection can cause dyspepsia and abdominal pain. It's a consideration, especially if the patient has been exposed to someone with a known infection or has recently traveled to an area with high prevalence.
• Irritable Bowel Syndrome (IBS): While IBS typically presents with abdominal pain associated with changes in bowel habits, some patients may experience upper abdominal symptoms. However, the primary complaint of throat burning is less typical for IBS.

Do Not Miss Diagnoses

• Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can present with abdominal pain, dyspepsia, and sometimes esophageal symptoms, although they are less common in this age group. Missing IBD could lead to significant morbidity.
• Esophageal Foreign Body or Structure: Although rare, an esophageal foreign body or a stricture could cause severe throat and chest pain, and it's crucial to rule out these conditions, especially if the patient reports difficulty swallowing or severe pain.
• Peptic Ulcer Disease: While less common in adolescents without risk factors (like NSAID use), peptic ulcers can cause severe abdominal pain and dyspepsia. The burning sensation could be consistent with a duodenal ulcer.

Rare Diagnoses

• Eosinophilic Esophagitis: This condition, characterized by an eosinophilic infiltration of the esophagus, can cause dysphagia, food impaction, and sometimes abdominal pain. It's more common in patients with atopic diseases but should be considered if common diagnoses are ruled out.
• Gastric Volvulus or Other Gastric Anomalies: These are rare conditions that could cause severe abdominal pain and dyspepsia but are less likely without a history of trauma or other specific risk factors.

Workup and Treatment

• Initial workup may include upper endoscopy to rule out esophageal and gastric pathology, including GERD, H. pylori infection, and peptic ulcers.
• Trial of proton pump inhibitors (PPIs) for suspected GERD.
• Consider breath test or stool antigen test for H. pylori if symptoms persist.
• If IBS is suspected, further evaluation may include stool tests for infection and inflammatory markers, but the diagnosis is often clinical.
• For Do Not Miss diagnoses, specific tests like blood work for inflammation (for IBD), esophageal manometry, or a barium swallow may be necessary based on clinical suspicion.

Treatment should be guided by the diagnosis, with lifestyle modifications (diet, weight loss if applicable, avoidance of trigger foods) and medications (antacids, H2 blockers, PPIs for GERD; antibiotics for H. pylori; aminosalicylates, corticosteroids, or biologics for IBD) as indicated.