Epigastric Pain Differential Diagnosis

Epigastric pain refers to a burning sensation or discomfort located in the upper abdominal region, just below the ribcage. The differential diagnosis for epigastric pain is broad and includes various gastrointestinal, cardiovascular, and other systemic conditions. Here's a categorized approach to the differential diagnosis:

• Single Most Likely Diagnosis
  • Gastroesophageal Reflux Disease (GERD): This condition is characterized by the reflux of stomach acid into the esophagus, leading to symptoms like heartburn and epigastric pain. It's a common condition that affects a significant portion of the population, making it the single most likely diagnosis for epigastric pain.
• Other Likely Diagnoses
  • Peptic Ulcer Disease: This includes both gastric and duodenal ulcers, which can cause epigastric pain that may be relieved by eating or worsened by certain foods. The pain is often described as burning or gnawing.
  • Gastritis: Inflammation of the stomach lining can cause epigastric pain, nausea, and vomiting. It can be acute or chronic and is often related to Helicobacter pylori infection or the use of nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Functional Dyspepsia: A condition characterized by recurring signs and symptoms of indigestion that have no obvious cause. Symptoms can include epigastric pain or discomfort, early satiety, and difficulty swallowing, among others.
• Do Not Miss Diagnoses
  • Myocardial Infarction: Although the classic symptom of a heart attack is chest pain, some patients, especially women and diabetics, may present with epigastric pain or discomfort. Missing this diagnosis can be fatal.
  • Pancreatitis: Both acute and chronic pancreatitis can present with severe epigastric pain that radiates to the back. This condition requires prompt medical attention.
  • Cholecystitis: Inflammation of the gallbladder, often due to gallstones, can cause right upper quadrant or epigastric pain, especially after eating fatty foods.
  • Esophageal Perforation: A rare but life-threatening condition that can cause severe chest or epigastric pain, often accompanied by difficulty swallowing and shortness of breath.
• 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 and epigastric pain.
  • Carcinoma of the Stomach or Pancreas: Although rare, cancers in these organs can present with epigastric pain, among other symptoms like weight loss and difficulty swallowing.
  • Sphincter of Oddi Dysfunction: A condition that affects the sphincter controlling the flow of bile and pancreatic juices into the intestine, causing recurrent biliary-type abdominal pain.

Each of these diagnoses has distinct characteristics and risk factors, and a thorough history, physical examination, and diagnostic tests (such as endoscopy, imaging studies, and blood tests) are essential for making an accurate diagnosis and guiding appropriate treatment.