Gastroesophageal Reflux Disease (GERD): This condition is characterized by the backflow of stomach acid into the esophagus, leading to sharp epigastric pain that can be intermittent. It's a common condition that matches the symptom profile closely.

Peptic Ulcer Disease: Both gastric and duodenal ulcers can cause sharp, intermittent epigastric pain, often related to eating or relieved by antacids.
Gallbladder Disease (Cholecystitis or Cholelithiasis): While gallbladder issues typically cause right upper quadrant pain, they can sometimes radiate to the epigastric area, especially if the gallbladder is inflamed or if a stone is obstructing the bile duct.
Functional Dyspepsia: A condition characterized by recurring signs and symptoms of indigestion that have no obvious cause, which can include sharp epigastric pain.

Myocardial Infarction: Although myocardial infarctions typically present with chest pain, in some cases, especially in women or diabetic patients, the pain can be atypical and present as epigastric discomfort. Missing this diagnosis can be fatal.
Pancreatitis: Acute pancreatitis can cause severe, sharp epigastric pain that radiates to the back. It's a serious condition that requires immediate medical attention.
Pulmonary Embolism: Similar to myocardial infarction, pulmonary embolism can sometimes present with atypical symptoms, including sharp epigastric pain if the embolism affects the lower parts of the lungs.

Esophageal Spasm: A rare condition where the esophagus experiences spasms, leading to sharp chest or epigastric pain.
Gastric Cancer: Although rare, gastric cancer can present with epigastric pain among other symptoms like weight loss and difficulty swallowing.
Splenic Infarction: Typically presents with left upper quadrant pain, but can occasionally cause epigastric pain if the spleen is involved, especially in patients with sickle cell disease or other conditions leading to splenic infarction.