What is the cause of a 78-year-old male's epigastric pain and bloating after consuming acidic food, with a history of coronary artery disease, hypertension, and recent rib fractures?

Differential Diagnosis for 78-year-old Male with Abdominal Symptoms

Single Most Likely Diagnosis

• Gastroesophageal Reflux Disease (GERD): The patient's symptoms of increased belching, nausea, abdominal pain after eating acidic food, and bloating are classic for GERD. The radiation of pain into the chest also supports this diagnosis, as GERD can cause esophageal irritation and discomfort that may be perceived as chest pain.

Other Likely Diagnoses

• Peptic Ulcer Disease: The patient's symptoms of abdominal pain and nausea after eating acidic food could also be consistent with peptic ulcer disease. The recent onset of symptoms and the description of the pain could suggest an ulcer.
• Functional Dyspepsia: Given the patient's chronic constipation and use of laxatives and stool softeners, functional dyspepsia is a possibility. This condition is characterized by recurring signs and symptoms of indigestion that have no obvious cause.
• Coronary Artery Disease with Gastrointestinal Symptoms: The patient's history of coronary artery disease and current evaluation for bradycardia raise the possibility that his symptoms could be cardiac in origin, with gastrointestinal symptoms being referred pain.

Do Not Miss Diagnoses

• Myocardial Infarction: Although the patient's symptoms are more suggestive of a gastrointestinal issue, his history of coronary artery disease and coronary artery calcification means that myocardial infarction must be considered, especially given the chest radiation of pain.
• Esophageal Rupture or Perforation: This is a rare but potentially life-threatening condition that could present with severe chest pain and abdominal symptoms, especially if the patient has been vomiting or has had significant straining.
• Pulmonary Embolism: While less likely given the gastrointestinal symptoms, pulmonary embolism can present with chest pain and must be considered in any patient with risk factors for thromboembolic disease.

Rare Diagnoses

• Gastric Cancer: Although rare, gastric cancer can present with nonspecific symptoms such as abdominal pain, nausea, and bloating. The patient's age and symptoms warrant consideration of this diagnosis, especially if his symptoms persist or worsen.
• Esophageal Spasm: This condition involves abnormal muscle contractions of the esophagus and can cause chest pain and difficulty swallowing. It is less common but could be considered if other diagnoses are ruled out.