Differential Diagnosis for Nocturnal Burning Sensation in Throat with Relief after Vomiting

Single Most Likely Diagnosis

• Gastroesophageal Reflux Disease (GERD): The symptoms of waking up in the middle of the night with a burning sensation in the throat that is relieved by vomiting are classic for GERD. The condition is exacerbated by lying down, which can cause stomach acid to flow more easily into the esophagus, leading to the described symptoms.

Other Likely Diagnoses

• Peptic Ulcer Disease: Although less common, peptic ulcers can cause nocturnal symptoms, including a burning sensation that may be temporarily relieved by vomiting, which can reduce acid production.
• Esophagitis: Inflammation of the esophagus, often due to acid reflux, can cause similar symptoms, including pain and burning that may worsen at night.

Do Not Miss Diagnoses

• Esophageal Cancer: Although rare, esophageal cancer can present with progressive dysphagia and nocturnal regurgitation or vomiting. It's crucial to consider this diagnosis, especially in patients with risk factors such as smoking or a history of Barrett's esophagus.
• Pulmonary Aspiration: The act of vomiting at night can lead to aspiration, which may result in pneumonia or other pulmonary complications. Identifying and managing the underlying cause of vomiting is critical to prevent these potentially life-threatening conditions.

Rare Diagnoses

• Eosinophilic Esophagitis: An inflammatory condition of the esophagus that can cause dysphagia, food impaction, and chest pain. While less common, it should be considered in patients who do not respond to typical GERD treatment.
• Zollinger-Ellison Syndrome: A rare disorder characterized by excessive gastric acid production due to a gastrin-secreting tumor. It can cause severe peptic ulcers and esophagitis, presenting with similar symptoms.

Each of these diagnoses should be considered in the context of the patient's overall clinical presentation, including their recent diagnosis of diverticulitis, which may or may not be directly related to their current symptoms. A thorough diagnostic workup, including endoscopy and potentially ambulatory acid probe tests, may be necessary to determine the underlying cause of their nocturnal symptoms.