Chronic Nausea Differential Diagnosis

The differential diagnosis for chronic nausea is extensive and can be categorized into several groups. Here's a breakdown of potential causes, organized by their likelihood and potential impact:

• Single Most Likely Diagnosis
  • Gastroesophageal reflux disease (GERD): This condition is characterized by the backflow of stomach acid into the esophagus, leading to symptoms like nausea, vomiting, and heartburn. Its high prevalence and common presentation make it a leading consideration for chronic nausea.
• Other Likely Diagnoses
  • Functional dyspepsia: A condition marked by recurring signs of indigestion that have no obvious cause. Symptoms can include nausea, bloating, and discomfort in the upper abdomen.
  • Irritable Bowel Syndrome (IBS): While primarily known for altering bowel habits, IBS can also cause nausea, especially in relation to eating or bowel movements.
  • Peptic ulcer disease: Ulcers in the stomach or duodenum can cause chronic nausea, along with pain and discomfort in the upper abdomen.
  • Inflammatory bowel disease (IBD): Conditions like Crohn's disease and ulcerative colitis can lead to chronic nausea among other gastrointestinal symptoms.
• Do Not Miss Diagnoses
  • Gastric cancer: Although less common, gastric cancer can present with chronic nausea and vomiting, making it crucial not to miss this diagnosis due to its severe implications.
  • Pancreatic cancer: Similar to gastric cancer, pancreatic cancer can cause chronic nausea, among other symptoms like weight loss and abdominal pain.
  • Medication-induced nausea: Certain medications, especially those used in chemotherapy, can cause prolonged nausea.
  • Pregnancy: In early pregnancy, nausea (morning sickness) can be persistent and is a critical diagnosis not to miss due to its implications for prenatal care.
• Rare Diagnoses
  • Gastroparesis: A condition where the stomach takes too long to empty its contents, leading to nausea, vomiting, and feeling full after eating only a small amount of food.
  • Cyclic vomiting syndrome: Characterized by episodes of severe nausea and vomiting that can last for hours or even days, with periods of normal health in between.
  • Superior mesenteric artery syndrome: A rare condition where the duodenum is compressed between the abdominal aorta and the superior mesenteric artery, leading to nausea, vomiting, and abdominal pain.
  • Brainstem or central nervous system disorders: Certain conditions affecting the brain, such as tumors or injuries, can cause chronic nausea due to their impact on the centers controlling nausea and vomiting.

Each of these diagnoses has a unique set of accompanying symptoms and diagnostic approaches, emphasizing the importance of a thorough medical history, physical examination, and targeted diagnostic tests to determine the underlying cause of chronic nausea.