Differential Diagnosis for 72-year-old Male with Upper Abdominal Pain
Single Most Likely Diagnosis
- Functional Dyspepsia: Given the patient's symptoms of upper abdominal pain, GERD, esophageal spasms, and audible gas bubbling in the upper abdomen, along with normal diagnostic tests (abdominal ultrasound, EGD), functional dyspepsia is a plausible diagnosis. This condition is characterized by recurring symptoms of upper abdominal discomfort or pain that are not explained by other pathologic conditions.
Other Likely Diagnoses
- Gastroparesis: The patient's symptoms of upper abdominal pain, nausea (implied by gas and discomfort), and the use of medications like oxycodone (which can slow gastric motility) suggest gastroparesis as a possible diagnosis. Although diagnostic tests like gastric emptying studies were not mentioned, the clinical presentation aligns with this condition.
- Irritable Bowel Syndrome (IBS): Although the patient has diverticulosis, the presence of gas, abdominal discomfort, and the absence of alarming features (e.g., blood in stool, significant weight loss) could also suggest IBS, particularly if the symptoms are predominantly related to bowel movements or are relieved by defecation.
- Medication-Induced Dyspepsia: The patient is on several medications (aspirin, oxycodone, rosuvastatin) that can cause or exacerbate dyspepsia. Aspirin and NSAIDs are well-known for their potential to cause gastric irritation and ulcers, while oxycodone can slow gastric emptying and contribute to nausea and vomiting.
Do Not Miss Diagnoses
- Peptic Ulcer Disease: Despite the normal EGD, peptic ulcer disease (PUD) must be considered, especially given the patient's use of aspirin, which increases the risk of gastric ulcers. A repeat or more detailed endoscopy might be warranted if symptoms persist or worsen.
- Pancreatic Cancer: Although the patient's pancreatic enzymes were normal, and there are no specific risk factors mentioned (like smoking or family history), pancreatic cancer can present with nonspecific symptoms such as abdominal pain and should not be entirely ruled out without further evaluation if symptoms persist.
- Ischemic Cardiomyopathy or Cardiac Ischemia: The patient's symptoms could be atypical presentations of cardiac ischemia, especially in an elderly patient. The normal troponins and the context of the symptoms are reassuring, but cardiac causes should always be considered in patients with chest or upper abdominal pain.
Rare Diagnoses
- Eosinophilic Esophagitis: This condition could explain the esophageal spasms and might be considered if the patient has a history of atopy or if other diagnoses are ruled out.
- Gastric or Intestinal Lymphoma: Although rare, lymphoma could present with nonspecific gastrointestinal symptoms and should be considered if the patient has systemic symptoms (e.g., weight loss, fever) or if other diagnoses are excluded.
- Scleroderma: This autoimmune disease can cause esophageal dysmotility and gastroparesis, presenting with symptoms similar to those described. However, other systemic symptoms of scleroderma (e.g., skin thickening, joint pain) would typically be present.