Differential Diagnosis for Chronic Nausea

Chronic nausea can be caused by a variety of conditions, ranging from gastrointestinal disorders to systemic diseases. Here's a categorized list of differentials for chronic nausea:

• Single Most Likely Diagnosis

  • Gastroesophageal reflux disease (GERD): This is a common condition where stomach acid frequently flows back into the tube connecting the mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of the esophagus, causing discomfort. Chronic nausea is a frequent symptom due to the persistent irritation and potential inflammation of the esophagus.

• Other Likely Diagnoses

  • Functional dyspepsia: Also known as non-ulcer stomach pain or indigestion, this condition is characterized by recurring signs and symptoms of indigestion that have no obvious cause. Symptoms can vary but often include nausea.
  • Irritable bowel syndrome (IBS): A common disorder that affects the large intestine, causing a variety of symptoms including cramping, abdominal pain, bloating, gas, diarrhea, and constipation. Nausea can also be a symptom, especially in relation to eating or bowel movements.
  • Inflammatory bowel disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause chronic inflammation and irritation in the digestive tract, leading to symptoms including nausea.
  • Gastroparesis: A condition where the stomach takes too long to empty its contents. This delay can cause nausea, vomiting, feeling full after eating only a small amount of food, and other symptoms.

• Do Not Miss Diagnoses

  • Pregnancy: Morning sickness is a well-known symptom of early pregnancy, but nausea can persist throughout the pregnancy. It's crucial to consider pregnancy as a cause of chronic nausea in women of childbearing age.
  • Medication side effects: Many medications can cause nausea as a side effect. Identifying and potentially changing the offending medication is crucial.
  • Thyroid disorders: Both hyperthyroidism and hypothyroidism can cause gastrointestinal symptoms, including nausea.
  • Malignancy: Certain cancers, such as stomach or pancreatic cancer, can cause chronic nausea. Although less common, missing a diagnosis of cancer can have severe consequences.

• Rare Diagnoses

  • Cyclic vomiting syndrome: A disorder that causes recurrent episodes of severe nausea and vomiting. These episodes can be severe and last for hours or even days.
  • Superior mesenteric artery syndrome: A rare condition where the duodenum (the first part of the small intestine) is compressed between the abdominal aorta and the superior mesenteric artery, leading to nausea, vomiting, and abdominal pain.
  • Chronic intestinal pseudo-obstruction: A rare condition where there are symptoms of bowel obstruction without any physical blockage. Symptoms can include severe nausea, vomiting, and abdominal pain.
  • Eosinophilic gastroenteritis: A rare condition characterized by the presence of eosinophils in the gastrointestinal tract, leading to inflammation and symptoms such as nausea, vomiting, and abdominal pain.

Each of these conditions has a different set of underlying causes and risk factors, and a thorough medical history, physical examination, and diagnostic tests are often necessary to determine the exact cause of chronic nausea.