Differential Diagnosis

The patient's symptoms of a sense of doom, burping, and episodes occurring 20-30 minutes after taking medications and drinking a shake, lasting about 20 minutes, can be analyzed as follows:

• Single Most Likely Diagnosis
  • Gastroesophageal Reflux Disease (GERD): The timing of symptoms after eating/drinking and the presence of burping suggest GERD. The sense of doom could be related to the discomfort or anxiety associated with the symptoms.
• Other Likely Diagnoses
  • Anxiety or Panic Disorder: Although the patient denies palpitations or sweating, the sense of doom is a classic symptom of panic attacks. The episodes could be triggered by the physical discomfort of GERD or other gastrointestinal issues.
  • Food Intolerance or Allergy: The symptoms occurring after drinking a shake could indicate an intolerance or allergy to a component of the shake, leading to gastrointestinal distress and possibly anxiety.
• Do Not Miss Diagnoses
  • Cardiac Ischemia or Myocardial Infarction: Although the patient denies palpitations or sweating, cardiac issues can sometimes present atypically, especially in women or diabetic patients. The sense of doom could be angina equivalent.
  • Pulmonary Embolism: A sudden onset of symptoms, including a sense of doom, could be indicative of a pulmonary embolism, which is a medical emergency.
• Rare Diagnoses
  • Eosinophilic Esophagitis: A rare condition characterized by inflammation of the esophagus that could cause symptoms similar to GERD, including food impaction and dysphagia, potentially triggering a sense of doom.
  • Gastroparesis: Delayed stomach emptying could lead to symptoms after eating, including nausea, vomiting, and abdominal bloating, potentially triggering anxiety or a sense of doom.