Differential Diagnosis for Epigastric Pain Worsening on Food Consumption

Single Most Likely Diagnosis

• Peptic Ulcer Disease (PUD): This condition is characterized by ulcers in the stomach or duodenum, often caused by Helicobacter pylori infection or NSAID use. The pain typically worsens with food consumption, especially in duodenal ulcers, due to the increased acid production stimulated by eating.

Other Likely Diagnoses

• Gastroesophageal Reflux Disease (GERD): While GERD symptoms can improve with eating in some cases, others may experience worsening symptoms due to increased pressure on the lower esophageal sphincter and subsequent reflux.
• Functional Dyspepsia: 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 with eating.
• Cholecystitis or Cholelithiasis: Inflammation of the gallbladder or gallstones can cause epigastric pain that worsens after eating, particularly fatty foods, due to the gallbladder's role in bile storage and release for fat digestion.

Do Not Miss Diagnoses

• Acute Coronary Syndrome (ACS): Although less common, epigastric discomfort can be a presenting symptom of myocardial infarction, especially in women, diabetics, or the elderly. The pain may be exacerbated by exertion, including the physical activity associated with eating.
• Pancreatitis: Both acute and chronic pancreatitis can present with severe epigastric pain that radiates to the back and worsens after eating, particularly fatty or heavy meals.
• Gastric Cancer: While rare, gastric cancer can cause epigastric pain that worsens with eating due to the tumor's effect on the stomach's ability to function normally.

Rare Diagnoses

• Zollinger-Ellison Syndrome: A rare disorder characterized by excessive gastric acid production due to a gastrin-producing tumor, leading to severe peptic ulcers and diarrhea. The epigastric pain can worsen with 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, and vomiting. Symptoms may worsen with eating, depending on the area of the GI tract affected.