Differential Diagnosis for Stomach Issues

The following is a differential diagnosis for stomach issues, categorized for clarity and importance.

• Single Most Likely Diagnosis

  • Gastroesophageal reflux disease (GERD): This is often the most common cause of stomach issues, characterized by symptoms such as heartburn, regurgitation, and difficulty swallowing. The high prevalence of GERD in the population and its association with common symptoms like heartburn make it a likely initial consideration.

• Other Likely Diagnoses

  • Peptic ulcer disease: This includes both gastric and duodenal ulcers, which can cause pain, nausea, and vomiting. The presence of Helicobacter pylori infection or the use of nonsteroidal anti-inflammatory drugs (NSAIDs) increases the likelihood of peptic ulcer disease.
  • Functional dyspepsia: Also known as non-ulcer dyspepsia or indigestion, this condition is characterized by recurring signs and symptoms of indigestion that have no obvious cause. It's a common condition that can significantly affect quality of life.
  • Inflammatory bowel disease (IBD): While IBD (including Crohn's disease and ulcerative colitis) primarily affects the intestines, it can also cause stomach symptoms. The presence of diarrhea, weight loss, and abdominal pain might suggest IBD.

• Do Not Miss Diagnoses

  • Gastric cancer: Although less common, gastric cancer is a critical diagnosis not to miss due to its significant morbidity and mortality. Risk factors include a family history of gastric cancer, Helicobacter pylori infection, and certain dietary factors.
  • Acute mesenteric ischemia: This is a life-threatening condition that occurs when the blood flow to the intestines is blocked. Symptoms can include severe abdominal pain, nausea, and vomiting. Prompt diagnosis and treatment are essential to prevent intestinal necrosis and death.
  • Appendicitis: While appendicitis typically presents with right lower quadrant abdominal pain, some cases can initially present with more generalized or upper abdominal pain, potentially mimicking stomach issues.

• Rare Diagnoses

  • Zollinger-Ellison syndrome: A rare disorder characterized by excessive gastric acid production due to a gastrin-secreting tumor. It leads to severe peptic ulcer disease and diarrhea.
  • Eosinophilic gastroenteritis: A rare condition where eosinophils infiltrate the gastrointestinal tract, leading to symptoms such as abdominal pain, nausea, and vomiting. It can be associated with food allergies or parasitic infections.
  • Gastric volvulus: A rare condition where the stomach abnormally twists, which can cause severe abdominal pain, nausea, and vomiting. It requires urgent medical attention to prevent complications.