Differential Diagnosis for 17-year-old with Epigastric Pain
- The patient's symptoms of epigastric pain, worse in the mornings before eating, and pain with palpation of the epigastric area can be evaluated based on the following categories:
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): This condition is a common cause of epigastric pain, especially when symptoms worsen before eating. The absence of vomiting and blood in the stool also supports this diagnosis, as GERD typically does not cause these symptoms.
Other Likely Diagnoses
- Peptic Ulcer Disease: Similar to GERD, peptic ulcers can cause epigastric pain that improves after eating. However, the presence of pain with palpation might suggest a more inflammatory or ulcerative process.
- Helena pylori Infection: Often associated with peptic ulcer disease, H. pylori infection can cause chronic epigastric pain and is a common cause of gastrointestinal symptoms in this age group.
Do Not Miss Diagnoses
- Gastric Cancer: Although rare in teenagers, gastric cancer can present with epigastric pain and should be considered, especially if other symptoms like weight loss or difficulty swallowing are present.
- Pancreatitis: Acute or chronic pancreatitis can cause severe epigastric pain, often radiating to the back, and can be life-threatening if not promptly diagnosed and treated.
- Eating Disorders: In a 17-year-old, eating disorders like bulimia nervosa can lead to epigastric pain due to frequent vomiting or other behaviors that strain the upper GI tract.
Rare Diagnoses
- Inflammatory Bowel Disease (IBD): While IBD (Crohn's disease or ulcerative colitis) can cause abdominal pain, it typically presents with changes in bowel habits, blood in the stool, or weight loss, which are not mentioned in this scenario.
- Gastric Volvulus: A rare condition where the stomach twists abnormally, causing severe epigastric pain and potentially life-threatening complications if not treated promptly.
- Congenital Anomalies: Certain congenital anomalies of the gastrointestinal tract, such as a gastric duplication cyst, could potentially cause chronic epigastric pain, although these are exceedingly rare and usually diagnosed earlier in life.