Differential Diagnosis

The patient presents with epigastric discomfort, heavy feeling after eating, and occasional chest discomfort. The following differential diagnoses are considered:

• Single most likely diagnosis
  • Gastro-oesophageal reflux disease (GORD): The patient's symptoms of epigastric discomfort, heavy feeling after eating, and occasional chest discomfort are consistent with GORD. The patient has a previous diagnosis of GORD and has responded to medication in the past.
• Other Likely diagnoses
  • Peptic ulcer disease: The patient's symptoms of epigastric discomfort and nausea could be consistent with peptic ulcer disease. The negative H. pylori stool test does not rule out this diagnosis, as other factors such as NSAID use or stress could contribute to ulcer formation.
  • Functional dyspepsia: The patient's symptoms of epigastric discomfort, heavy feeling after eating, and nausea could also be consistent with functional dyspepsia.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Myocardial infarction: Although the patient's symptoms are more consistent with GORD, the occasional chest discomfort and family history of sudden cardiac death make it essential to consider myocardial infarction as a potential diagnosis.
  • Oesophageal rupture or perforation: Although rare, oesophageal rupture or perforation can present with severe chest pain and epigastric discomfort, making it a critical diagnosis not to miss.
• Rare diagnoses
  • Gastric cancer: Although the patient's symptoms are more consistent with GORD, gastric cancer can present with epigastric discomfort, weight loss, and nausea, making it a rare but potential diagnosis to consider.
  • Zollinger-Ellison syndrome: This rare condition is characterized by excessive gastric acid production and can present with symptoms similar to GORD, making it a rare but potential diagnosis to consider.