Differential Diagnosis for Epigastric Pain with Vomiting

Single Most Likely Diagnosis

• Gastroesophageal Reflux Disease (GERD): This condition is characterized by the backflow of stomach acid into the esophagus, leading to symptoms like epigastric pain and vomiting. The chronic nature of the symptoms (6 months) and the presence of vomiting align with GERD, especially if the pain is exacerbated by food intake or lying down.

Other Likely Diagnoses

• Peptic Ulcer Disease: This includes both gastric and duodenal ulcers, which can cause epigastric pain and vomiting. The pain is often described as burning and can be relieved by eating or taking antacids.
• Functional Dyspepsia: A condition where there is persistent or recurrent pain or discomfort in the upper abdomen, often accompanied by symptoms like bloating, early satiety, or nausea. It's a diagnosis of exclusion after ruling out other causes.
• Chronic Gastritis: Inflammation of the stomach lining can lead to epigastric pain, nausea, and vomiting. It can be caused by infection (e.g., H. pylori), alcohol, or other irritants.

Do Not Miss Diagnoses

• Pancreatic Cancer: Although less common, pancreatic cancer can present with epigastric pain and vomiting, especially if the tumor obstructs the pancreatic duct or duodenum. Weight loss and jaundice may also be present.
• Gastric Cancer: Similar to pancreatic cancer, gastric cancer can cause epigastric pain, vomiting, and weight loss. Early detection is crucial for treatment.
• Esophageal Obstruction or Stricture: Conditions that narrow the esophagus can cause difficulty swallowing, regurgitation, and vomiting. These can be due to chronic inflammation, cancer, or other causes.

Rare Diagnoses

• Zollinger-Ellison Syndrome: A rare disorder characterized by excessive gastric acid production due to a gastrin-secreting tumor, leading to severe peptic ulcers and diarrhea.
• Eosinophilic Esophagitis or Gastritis: Conditions where eosinophils infiltrate the esophagus or stomach, often due to allergic reactions, leading to symptoms like dysphagia, food impaction, and abdominal pain.
• Celiac Disease: An autoimmune reaction to gluten that can cause abdominal pain, diarrhea, and vomiting, although it more commonly presents with malabsorption symptoms.

Each of these diagnoses requires careful consideration of the patient's history, physical examination, and diagnostic tests (like endoscopy, imaging studies, and laboratory tests) to determine the underlying cause of the epigastric pain and vomiting.