Differential Diagnosis for 21y F with Acid Indigestion, Weight Loss, Nausea, and No Relief from Omeprazole
- Single Most Likely Diagnosis
- Gastroesophageal reflux disease (GERD) with inadequate response to omeprazole or non-adherence: This is a common condition that could explain the symptoms of acid indigestion and nausea. The lack of response to omeprazole might indicate the need for a higher dose, a different proton pump inhibitor, or adherence issues.
- Other Likely Diagnoses
- Peptic ulcer disease: The symptoms of acid indigestion and nausea could be indicative of a peptic ulcer, especially if the patient has been taking nonsteroidal anti-inflammatory drugs (NSAIDs) or has a history of Helicobacter pylori infection.
- Functional dyspepsia: This condition involves persistent or recurrent upper abdominal pain or discomfort that is not explained by other pathologic conditions. It could be a consideration if other diagnoses are ruled out.
- Inflammatory bowel disease (IBD): Although less common, IBD (including Crohn's disease and ulcerative colitis) could present with weight loss, nausea, and abdominal discomfort, and might not respond to omeprazole.
- Do Not Miss Diagnoses
- Gastric cancer: Although rare in young individuals, gastric cancer is a critical diagnosis not to miss, as it can present with nonspecific symptoms like weight loss, nausea, and abdominal discomfort.
- Zollinger-Ellison syndrome: A rare disorder characterized by excessive gastric acid production due to a gastrin-secreting tumor, which could explain the lack of response to omeprazole.
- Eosinophilic esophagitis: An immune system disorder that could cause difficulty swallowing, food impaction, and heartburn, which might not respond to standard acid reflux treatment.
- Rare Diagnoses
- Celiac disease: An autoimmune disorder where the ingestion of gluten leads to damage in the small intestine, which could cause weight loss, nausea, and abdominal discomfort.
- Gastroparesis: A condition where the stomach takes too long to empty its contents, which could lead to nausea, vomiting, and weight loss, and might not respond to typical treatments for acid reflux.
- Intestinal lymphoma: A type of cancer that affects the immune system and could present with nonspecific gastrointestinal symptoms, including weight loss and nausea.