Differential Diagnosis for 36-year-old Male with Abdominal Discomfort
- Single most likely diagnosis:
- Irritable Bowel Syndrome (IBS) - The patient's history of recurrent, self-limiting abdominal discomfort, diarrhea, and lack of relief with omeprazole (suggesting that acid reflux is not the primary issue) points towards IBS. The migratory nature of the pain and the absence of nausea and vomiting also support this diagnosis.
- Other Likely diagnoses:
- Functional Dyspepsia - Given the epigastric location of the pain and the patient's lack of response to omeprazole, functional dyspepsia is a consideration. However, the migratory nature of the pain and the presence of diarrhea are less typical for this condition.
- Inflammatory Bowel Disease (IBD) - Although less likely given the patient's long history of similar symptoms without significant weight loss, blood in stool, or other alarming signs, IBD (such as Crohn's disease or ulcerative colitis) could be considered, especially if the diarrhea is a new or worsening symptom.
- Do Not Miss diagnoses:
- Appendicitis - Although the patient's symptoms have been present for two weeks, which is longer than typical for appendicitis, and the pain has migrated, appendicitis can present atypically, especially in adults. The location of the pain in the right lower quadrant (RLQ) necessitates consideration of this diagnosis.
- Intestinal Obstruction - The presence of abdominal pain, diarrhea, and a history of similar episodes could, in rare cases, suggest intermittent intestinal obstruction, which is a medical emergency.
- Mesenteric Ischemia - This condition, although rare, can cause severe abdominal pain out of proportion to physical findings and can be a cause of chronic or recurrent abdominal pain if it is intermittent.
- Rare diagnoses:
- Chronic Intestinal Pseudo-obstruction - A rare condition characterized by recurrent episodes of abdominal pain, nausea, vomiting, and altered bowel habits in the absence of any mechanical obstruction.
- Eosinophilic Gastroenteritis - A rare condition that can cause abdominal pain, diarrhea, and other gastrointestinal symptoms due to eosinophilic infiltration of the gastrointestinal tract.
- Abdominal Migraine - A condition more commonly seen in children but can occur in adults, characterized by recurrent episodes of severe abdominal pain, often accompanied by other migraine-like symptoms.