Differential Diagnosis

The patient presents with severe epigastric and periumbilical pain that worsens after defecation, particularly after consuming sweet things. The symptoms have been ongoing for six months without weight loss or other accompanying symptoms. Here is a differential diagnosis based on the provided information:

• Single Most Likely Diagnosis

  • Irritable Bowel Syndrome (IBS): This condition is characterized by abdominal pain associated with changes in bowel habits, which can include worsening of pain after defecation. The exacerbation of symptoms by sweet foods could be related to dietary triggers common in IBS. The absence of weight loss and other systemic symptoms also supports this diagnosis.

• Other Likely Diagnoses

  • Gastroesophageal Reflux Disease (GERD): Although GERD typically presents with heartburn and regurgitation, some patients may experience epigastric pain, especially after eating. The consumption of sweet foods could potentially trigger or worsen GERD symptoms in susceptible individuals.
  • Functional Dyspepsia: This condition involves persistent or recurrent upper abdominal pain or discomfort that is not exclusively relieved by defecation or associated with the onset of a stool. The pain can be exacerbated by eating, which aligns with the patient's experience of worsening symptoms after consuming sweet foods.
  • Lactose Intolerance or Fructose Malabsorption: If the patient's diet is high in lactose or fructose (found in many sweet foods), malabsorption could lead to bloating, gas, and abdominal pain, particularly after consuming these substances.

• Do Not Miss Diagnoses

  • Pancreatitis: Although less likely given the chronic nature of the symptoms and the lack of other systemic symptoms, pancreatitis (especially chronic pancreatitis) can present with abdominal pain that worsens after eating. It is crucial to consider this diagnosis due to its potential severity and the need for specific management.
  • Gastric or Duodenal Ulcer: Peptic ulcers can cause epigastric pain that may be related to eating. While the pattern of pain worsening after defecation is not typical, it's essential to rule out ulcers due to their potential for complications like bleeding or perforation.
  • Colorectal Cancer: Although the patient's age and lack of weight loss make this less likely, it is a diagnosis that must be considered, especially if there are changes in bowel habits or if the pain is persistent and unexplained.

• Rare Diagnoses

  • Celiac Disease: An autoimmune reaction to gluten can cause abdominal pain, bloating, and changes in bowel habits. While less common, it should be considered, especially if the patient experiences relief from symptoms when avoiding gluten.
  • Small Intestine Bacterial Overgrowth (SIBO): This condition involves an abnormal increase in the bacteria population of the small intestine, leading to bloating, gas, and abdominal pain, which could potentially worsen after eating certain foods, including sweets.