Differential Diagnosis

The patient's symptoms and history suggest a gastrointestinal issue, and the following differential diagnoses are considered:

• Single most likely diagnosis
  • Functional Dyspepsia: The patient's symptoms of dull pain in the stomach area, worsening with bending or twisting, and improvement with antacids and acid reducers, are consistent with functional dyspepsia. The lack of a clear diagnosis after endoscopy and the variable response to different foods also support this diagnosis.
• Other Likely diagnoses
  • Gastritis: The patient's history of consuming spicy food and coffee, which can irritate the stomach lining, and the improvement with Pepto Bismol and aloe juice, suggest gastritis as a possible diagnosis.
  • Irritable Bowel Syndrome (IBS): The patient's symptoms of abdominal pain, variable triggers, and improvement with certain foods or drinks, could also be consistent with IBS.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Peptic Ulcer Disease: Although the patient's endoscopy did not show GERD, a peptic ulcer could still be present, and it is essential to rule out this diagnosis due to the risk of bleeding or perforation.
  • Gastrointestinal Cancer: Although rare in a 30-year-old, gastrointestinal cancer should be considered, especially if the patient's symptoms persist or worsen over time.
• Rare diagnoses
  • Inflammatory Bowel Disease (IBD): The patient's symptoms could be consistent with IBD, such as Crohn's disease or ulcerative colitis, although this would be less likely given the patient's age and lack of other symptoms like diarrhea or weight loss.
  • Gastroparesis: The patient's symptoms of abdominal pain and variable response to food could also be consistent with gastroparesis, a condition characterized by delayed gastric emptying. However, this diagnosis would be less likely without other symptoms like nausea or vomiting.