Differential Diagnosis for Peptic Ulcer Disease (PUD) vs. Gastroesophageal Reflux Disease (GERD)
When differentiating between Peptic Ulcer Disease (PUD) and Gastroesophageal Reflux Disease (GERD), it's crucial to consider the clinical presentation, diagnostic findings, and potential complications of each condition. Here's a structured approach to the differential diagnosis:
Single Most Likely Diagnosis:
- Peptic Ulcer Disease (PUD) if the patient presents with epigastric pain that is relieved by food or antacids, especially if there's a history of NSAID use or Helicobacter pylori infection.
- Gastroesophageal Reflux Disease (GERD) if the patient complains of heartburn, regurgitation, or dysphagia, particularly if symptoms worsen with lying down or improve with antacids.
Other Likely Diagnoses:
- Functional Dyspepsia: Considered when patients have chronic or recurrent upper abdominal symptoms (such as epigastric pain or discomfort) without evidence of organic disease.
- Gastritis: Especially if there's a history of alcohol use, NSAIDs, or stress, presenting with epigastric pain and possibly nausea or vomiting.
- Esophagitis: If the patient has symptoms of GERD but also presents with difficulty swallowing or food getting stuck, suggesting esophageal inflammation.
Do Not Miss Diagnoses:
- Malignancy (e.g., Gastric or Esophageal Cancer): Although less common, it's critical to rule out cancer, especially in older patients or those with significant weight loss, difficulty swallowing, or anemia.
- Zollinger-Ellison Syndrome: A rare condition characterized by excessive gastric acid production due to a gastrin-secreting tumor, presenting with severe peptic ulcers or diarrhea.
- Eosinophilic Esophagitis: An inflammatory condition of the esophagus that can mimic GERD but requires specific treatment, often presenting with dysphagia or food impaction.
Rare Diagnoses:
- Pyloric Stenosis: A condition where the pylorus (the passage between the stomach and small intestine) narrows, causing vomiting and abdominal pain, more common in infants but can occur in adults.
- Gastroparesis: A condition where the stomach takes too long to empty its contents, often presenting with nausea, vomiting, and feeling full after eating only a small amount of food.
- Infectious Esophagitis: Caused by fungi (e.g., Candida), viruses (e.g., HSV, CMV), or bacteria, more commonly seen in immunocompromised patients.
Each of these diagnoses has distinct clinical features and diagnostic approaches. A thorough history, physical examination, and judicious use of diagnostic tests (such as endoscopy, ambulatory acid probe tests, and imaging studies) are essential for accurately differentiating between PUD and GERD and considering other potential diagnoses.