Differential Diagnosis for Abdominal Discomfort without Burning Sensation

The chief complaints that point towards Irritable Bowel Syndrome (IBS) include recurrent abdominal pain or discomfort associated with a change in bowel habits, such as diarrhea, constipation, or alternating between the two, without any evidence of an inflammatory, infectious, or structural cause. When considering abdominal discomfort without a burning sensation, the differential diagnosis can be broad. Here's an organized approach:

• Single Most Likely Diagnosis
  • Irritable Bowel Syndrome (IBS): Given the description, IBS is a leading consideration due to its prevalence and the nature of symptoms that include abdominal discomfort and alterations in bowel habits without an identifiable cause.
• Other Likely Diagnoses
  • Functional Dyspepsia: Characterized by persistent or recurrent upper abdominal discomfort or pain that is not exclusively relieved by defecation or associated with the onset of a bowel movement, and without evidence of organic disease.
  • Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can present with abdominal discomfort, changes in bowel habits, and sometimes without a burning sensation, especially in mild cases or early stages.
  • Gastroesophageal Reflux Disease (GERD): While often associated with a burning sensation, some patients may experience GERD as abdominal discomfort without the typical heartburn.
• Do Not Miss Diagnoses
  • Appendicitis: Although classically presents with pain migrating to the right lower quadrant, some cases may have atypical presentations, including generalized or upper abdominal discomfort without a clear burning sensation.
  • Mesenteric Ischemia: A condition that can present with severe, diffuse abdominal pain out of proportion to physical examination findings, without a burning quality, and is a medical emergency.
  • Ovarian Torsion: In females, this condition can cause severe, acute abdominal pain that may not have a burning character, and is an emergency requiring prompt surgical intervention.
• Rare Diagnoses
  • Celiac Disease: An autoimmune reaction to gluten that can cause abdominal discomfort, diarrhea, and malabsorption, but is less common than IBS or functional dyspepsia.
  • Gastroparesis: A condition characterized by delayed stomach emptying, which can cause abdominal discomfort, nausea, and vomiting, but is less frequently encountered than other diagnoses listed here.
  • Intestinal Obstruction: While typically presents with severe abdominal pain, vomiting, and obstipation, early or partial obstruction might manifest as abdominal discomfort without a burning sensation.

Each diagnosis is considered based on the nature of the abdominal discomfort, associated symptoms, and the potential for serious underlying conditions that must not be missed. A thorough history, physical examination, and judicious use of diagnostic tests are essential for narrowing down the differential diagnosis.