Epigastric Pain Differential Diagnosis

Epigastric pain can be caused by a variety of conditions, ranging from benign to life-threatening. Here's a differential diagnosis organized into categories:

• Single Most Likely Diagnosis
  • Gastroesophageal reflux disease (GERD) - This is often the most common cause of epigastric pain due to the high prevalence of GERD in the general population. Symptoms such as heartburn and regurgitation, especially after eating or at night, support this diagnosis.
• Other Likely Diagnoses
  • Peptic ulcer disease (PUD) - Both gastric and duodenal ulcers can cause epigastric pain, often described as burning or gnawing, and can be related to food intake.
  • Functional dyspepsia - This condition, also known as non-ulcer dyspepsia or indigestion, is characterized by recurring signs and symptoms of indigestion that have no obvious cause.
  • Gallbladder disease (cholecystitis or cholelithiasis) - While gallbladder disease typically causes right upper quadrant pain, it can sometimes radiate to the epigastrium.
• Do Not Miss Diagnoses
  • Myocardial infarction - Although chest pain is the hallmark of a heart attack, some patients, especially women and diabetics, may present with epigastric pain as the primary symptom.
  • Pancreatitis - Acute pancreatitis can cause severe, persistent epigastric pain that radiates to the back, and it is crucial to diagnose promptly due to its potential severity.
  • Esophageal rupture or perforation - A rare but life-threatening condition that requires immediate medical attention.
  • Aortic dissection - This is a medical emergency where the inner layer of the aorta tears, and while it typically presents with severe back or chest pain, epigastric pain can be a part of the symptom complex.
• Rare Diagnoses
  • Gastric cancer - Although rare, especially in younger populations, gastric cancer can present with epigastric pain, weight loss, and other non-specific symptoms.
  • Pancreatic cancer - Similar to gastric cancer, pancreatic cancer is rare but can cause epigastric pain, especially if the tumor is located in the head of the pancreas.
  • Splenic infarction or rupture - These conditions can cause severe abdominal pain, which may initially be localized to the epigastrium before becoming more generalized.
  • Superior mesenteric artery syndrome - A rare condition where the duodenum is compressed between the abdominal aorta and the superior mesenteric artery, causing epigastric pain and other gastrointestinal symptoms.