Differential Diagnosis for Untreatable GERD, Nausea, Vomiting with Abdominal Pain

Single Most Likely Diagnosis

• Gastroesophageal Reflux Disease (GERD) with Gastritis or Peptic Ulcer Disease: This is the most likely diagnosis given the symptoms of untreatable GERD, nausea, vomiting, and abdominal pain. The presence of these symptoms suggests a severe form of GERD that may have led to complications such as gastritis or peptic ulcer disease, which can cause abdominal pain and exacerbate GERD symptoms.

Other Likely Diagnoses

• Functional Dyspepsia: This condition is characterized by recurring symptoms of upper abdominal pain or discomfort that are not explained by other pathologic conditions. It could be a contributing factor to the symptoms described, especially if there's an overlap with GERD symptoms.
• Irritable Bowel Syndrome (IBS): Although primarily associated with altered bowel habits, IBS can also cause nausea, vomiting, and abdominal pain, which might be confused with or exacerbate GERD symptoms.
• Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause abdominal pain, nausea, vomiting, and may have an association with GERD symptoms due to the overall inflammatory nature of the disease.

Do Not Miss Diagnoses

• Gastric Cancer: Although less common, gastric cancer can present with symptoms of abdominal pain, nausea, vomiting, and difficulty managing GERD. It's crucial to rule out this diagnosis due to its severe implications.
• Pancreatitis: Acute or chronic pancreatitis can cause severe abdominal pain, nausea, and vomiting. It's a condition that requires immediate medical attention and could be masked by or contribute to the symptoms of GERD.
• Esophageal Stricture or Obstruction: Conditions that cause narrowing or blockage of the esophagus can lead to severe symptoms of dysphagia, regurgitation, and potentially abdominal pain if associated with GERD.

Rare Diagnoses

• Zollinger-Ellison Syndrome: A rare disorder characterized by excessive gastric acid production due to a gastrin-secreting tumor, leading to severe peptic ulcers, diarrhea, and abdominal pain.
• Eosinophilic Esophagitis: An inflammatory condition of the esophagus that can cause difficulty swallowing, food impaction, and abdominal pain, potentially mimicking severe GERD symptoms.
• Scleroderma: A chronic autoimmune disease that can affect the esophagus, leading to dysphagia, regurgitation, and potentially abdominal pain due to gastrointestinal involvement.