What is the likely diagnosis and treatment for a 22-year-old patient with morning stomach pain and a burning sensation in the throat after consuming spicy food?

Likely Diagnosis and Treatment for a 22-Year-Old with Morning Stomach Pain and Throat Burning After Spicy Food

This patient most likely has gastroesophageal reflux disease (GERD) with overlapping functional dyspepsia, and should be started immediately on a proton pump inhibitor (omeprazole 20 mg once daily before meals) for 4-8 weeks, combined with lifestyle modifications including avoidance of spicy foods and eating at least 4 hours before bedtime. 1, 2, 3

Clinical Reasoning

The combination of epigastric/stomach pain triggered by specific foods (spicy) and a burning sensation radiating to the throat is highly characteristic of GERD. The burning sensation that starts in the epigastrium and radiates to the chest/throat is the key distinguishing feature of GERD heartburn versus dyspeptic epigastric pain alone. 1

At age 22 without alarm symptoms (no weight loss, no dysphagia, no vomiting), this patient does not require urgent endoscopy and can be managed empirically. 1

Differential Diagnosis Considerations

While GERD is most likely, approximately one-third of patients with functional dyspepsia have coexisting gastro-oesophageal reflux symptoms. 1 The morning timing of stomach pain and food-triggered symptoms could represent:

• GERD (most likely): The throat burning is pathognomonic for acid reflux 1, 4, 5
• Functional dyspepsia with GERD overlap: Common in young patients, occurring in up to 50% of cases 1
• Epigastric pain syndrome (EPS): A subtype of functional dyspepsia where pain can be induced by meal ingestion 1

Initial Diagnostic Workup

No imaging or endoscopy is required at this age without alarm symptoms. 1 However, baseline investigations should include:

• H. pylori testing (breath or stool test): Essential for all patients with dyspeptic symptoms 1, 6
• Full blood count: Recommended for patients aged ≥25 years, though this patient is 22 1, 6
• Coeliac serology: Only if overlapping IBS-type symptoms are present 1, 6

First-Line Treatment Protocol

Pharmacotherapy

Start omeprazole 20 mg once daily taken before meals for 4-8 weeks. 2, 6, 3 This is the standard first-line treatment for GERD and provides symptomatic relief within 24 hours in most patients. 7, 4

• Omeprazole should be taken exactly as prescribed, at the lowest effective dose for the shortest time needed 3
• The capsule should be swallowed whole before a meal 3
• If H. pylori testing is positive, eradication therapy with antibiotics for 10-14 days is required, followed by reassessment 6

Lifestyle Modifications (Critical Component)

Dietary changes:

• Avoid spicy foods completely: These are established triggers for GERD symptoms 8, 9
• Avoid fatty/fried foods, chocolate, coffee, carbonated beverages, and alcohol 8, 9
• Avoid citrus juices (orange, grapefruit) and tomato products 8

Eating habits:

• Eat dinner at least 4 hours before bedtime: Short meal-to-sleep interval significantly increases reflux episodes 9
• Avoid large-volume meals; eat smaller, more frequent meals 8
• Establish a regular meal pattern 8

Other modifications:

• Elevate head of bed if nighttime symptoms occur 4
• Maintain healthy body weight 4, 8
• Avoid vigorous physical activity immediately after meals 8

Follow-Up and Reassessment

• If symptoms improve after 4-8 weeks: Step down to minimal dose PPI or discontinue if asymptomatic 6
• If symptoms persist despite PPI therapy: Consider non-urgent endoscopy to evaluate for erosive esophagitis or other structural causes 1
• If symptoms worsen or alarm features develop (weight loss, dysphagia, persistent vomiting): Urgent endoscopy is required 1

Common Pitfalls to Avoid

• Do not assume functional dyspepsia without first treating GERD: The throat burning is a red flag for acid reflux that requires acid suppression 1, 2
• Do not delay H. pylori testing: This is a modifiable risk factor that requires eradication 1, 6
• Do not recommend restrictive diets that can lead to malnutrition: Focus on avoiding specific triggers rather than eliminating entire food groups 6
• Do not ignore the importance of meal timing: The short-meal-to-sleep interval is one of the most consistent modifiable risk factors 9

Patient Education

Explain that GERD is a chronic condition related to acid reflux from the stomach into the esophagus and throat. 1 Emphasize that while medications control symptoms, lifestyle modifications are essential for long-term management and may allow eventual discontinuation of medication. 1, 4 The burning throat sensation confirms acid is reaching the upper esophagus, making dietary triggers and meal timing particularly important. 1, 9