Differential Diagnosis for Intermittent Sharp, Burning Pain in the Upper Midline Abdomen

Single Most Likely Diagnosis

• Gastroesophageal Reflux Disease (GERD): This condition is characterized by the backflow of stomach acid into the esophagus, causing sharp, burning pain in the upper midline abdomen. The intermittent nature of the pain and its location are consistent with GERD, especially if symptoms worsen after eating or at night.

Other Likely Diagnoses

• Peptic Ulcer Disease: Peptic ulcers can cause sharp, burning pain in the upper abdomen, which may be intermittent and can be related to eating. The pain is typically localized to the midline or slightly off-center.
• Gastritis: Inflammation of the stomach lining can lead to sharp, burning pain in the upper midline abdomen. This pain can be intermittent and may be exacerbated by eating certain foods or drinking alcohol.
• Functional Dyspepsia: This condition involves recurring signs and symptoms of indigestion that have no obvious cause. Symptoms can include sharp, burning pain in the upper abdomen, though the pain is often more diffuse and not as localized as in other conditions.

Do Not Miss Diagnoses

• Myocardial Infarction: Although less common, myocardial infarction (heart attack) can present with abdominal pain, especially in women, diabetics, and the elderly. The pain can be sharp and burning, and it is crucial not to miss this diagnosis due to its high mortality rate if untreated.
• Pancreatitis: Acute pancreatitis can cause severe, sharp abdominal pain that radiates to the back. While the pain is often more constant, it can have periods where it feels sharper or more burning, especially if the pancreas becomes inflamed.
• Pulmonary Embolism: In rare cases, a pulmonary embolism can cause referred pain to the upper abdomen if the embolism affects the lung bases. This is a life-threatening condition that requires immediate medical attention.

Rare Diagnoses

• Esophageal Spasm: This condition involves abnormal muscle contractions of the esophagus, which can cause sharp, burning chest pain that may radiate to the abdomen.
• Abdominal Migraine: A condition that causes recurrent episodes of severe abdominal pain, often accompanied by other migraine symptoms like headache or nausea. The pain can be sharp and burning.
• Celiac Plexus Neuropathy: Damage to the nerves in the celiac plexus can cause severe, sharp abdominal pain that is usually constant but can have intermittent exacerbations.