Differential Diagnosis for Epigastric Pain at Night
- Single Most Likely Diagnosis
- Gastroesophageal reflux disease (GERD): This condition is a common cause of epigastric pain that can worsen at night due to increased acid production and relaxation of the lower esophageal sphincter when lying down.
- Other Likely Diagnoses
- Peptic ulcer disease: Ulcers in the stomach or duodenum can cause epigastric pain that may worsen at night, especially if the patient has an empty stomach.
- Functional dyspepsia: This condition, also known as non-ulcer dyspepsia, can cause recurring epigastric pain or discomfort, often related to eating or at night.
- Gallbladder disease (cholecystitis or cholelithiasis): Gallstones or inflammation of the gallbladder can cause epigastric pain, especially after eating fatty foods, which may be more noticeable at night.
- Do Not Miss Diagnoses
- Myocardial infarction (heart attack): Although less common, myocardial infarction can present with epigastric pain, especially in women, and is a medical emergency.
- Pancreatitis: Inflammation of the pancreas can cause severe epigastric pain that radiates to the back and worsens at night.
- Gastric cancer: Although rare, gastric cancer can cause epigastric pain, weight loss, and other symptoms, making it crucial not to miss this diagnosis.
- Rare Diagnoses
- Zollinger-Ellison syndrome: A rare condition characterized by excessive gastric acid production due to a gastrin-producing tumor, leading to severe peptic ulcers and epigastric pain.
- Intestinal obstruction or ischemia: Conditions affecting the small intestine, such as obstruction or ischemia, can cause severe abdominal pain, including epigastric pain at night.
- Sphincter of Oddi dysfunction: A rare condition affecting the sphincter that regulates bile and pancreatic juice flow, causing abdominal pain, including epigastric pain.