Differential Diagnosis for 12-year-old Male Patient with Upper Abdominal Discomfort
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): The patient's symptoms of indigestion in the upper abdomen, especially after eating raw vegetables, and the sensation similar to needing to burp but cannot, are classic for GERD. This condition is common in children and can be exacerbated by certain foods.
Other Likely Diagnoses
- Functional Dyspepsia: This condition involves recurring signs and symptoms of indigestion that have no obvious cause. Symptoms can include pain or discomfort in the upper abdomen, which might be exacerbated by eating, similar to what the patient is experiencing.
- Irritable Bowel Syndrome (IBS): Although IBS typically presents with abdominal pain associated with changes in bowel habits, some patients might experience upper abdominal discomfort, especially if they have an overlap with functional dyspepsia.
Do Not Miss Diagnoses
- Pyloric Stenosis: Although more common in infants, pyloric stenosis can occasionally present in older children. It causes severe vomiting and abdominal pain, which could be mistaken for indigestion.
- Gastric or Duodenal Ulcer: Peptic ulcers can cause epigastric pain that worsens with eating and can be associated with nausea and vomiting. Although less common in children, they should not be missed due to potential complications.
- Esophageal Foreign Body or Food Impaction: This is an emergency that could present with sudden onset of severe chest pain or discomfort, especially if the patient has a history of eating quickly or not chewing food properly.
Rare Diagnoses
- Eosinophilic Esophagitis: An allergic inflammatory condition of the esophagus that can cause difficulty swallowing, food impaction, and chest pain. It's more common in patients with a history of allergies or asthma.
- Celiac Disease: An autoimmune disorder where the ingestion of gluten leads to damage in the small intestine. It can cause abdominal pain, bloating, and diarrhea, but sometimes the symptoms can be more nonspecific, including upper abdominal discomfort.
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause a wide range of gastrointestinal symptoms, including abdominal pain, which might initially be mistaken for indigestion.