Differential Diagnosis for Abdominal Discomfort in the Elderly (Excluding Pain)

Single Most Likely Diagnosis

• Constipation: This is a common issue in the elderly due to decreased mobility, changes in diet, and the use of certain medications. It can cause significant abdominal discomfort without necessarily being painful.

Other Likely Diagnoses

• Gastroesophageal Reflux Disease (GERD): Elderly individuals may experience discomfort due to acid reflux, which can be exacerbated by lying down or eating certain foods.
• Irritable Bowel Syndrome (IBS): Although more common in younger populations, IBS can occur in the elderly, leading to abdominal discomfort, bloating, and changes in bowel habits.
• Diverticulitis: While it can cause pain, some elderly patients might experience discomfort without overt pain, especially if the condition is mild or they have a high pain threshold.
• Gallbladder Disease: Biliary colic or chronic gallbladder inflammation can cause discomfort rather than sharp pain, especially in older adults.

Do Not Miss Diagnoses

• Mesenteric Ischemia: This condition, which involves insufficient blood flow to the intestines, can present with non-specific abdominal discomfort before progressing to severe pain. It's critical to identify early due to its high mortality rate.
• Abdominal Aortic Aneurysm: Although typically painless, an expanding or ruptured aneurysm can cause discomfort or a sense of impending doom. Early detection is crucial for survival.
• Intestinal Obstruction: This can cause severe discomfort and is a medical emergency. Early diagnosis is key to preventing complications.

Rare Diagnoses

• Celiac Disease: An autoimmune reaction to gluten, which can cause abdominal discomfort, diarrhea, and malabsorption. It's less common but should be considered, especially with unexplained weight loss or anemia.
• Inflammatory Bowel Disease (Crohn's Disease or Ulcerative Colitis): While more common in younger populations, these conditions can be diagnosed at any age and may present with chronic abdominal discomfort among other symptoms.
• Neuroendocrine Tumors: Rare tumors that can produce various peptides leading to different syndromes, some of which may cause abdominal discomfort among a myriad of other symptoms.

Each of these diagnoses requires careful consideration of the patient's history, physical examination, and potentially, diagnostic tests to determine the underlying cause of abdominal discomfort.