Differential Diagnosis
- Single most likely diagnosis
- Recurrence of H. pylori infection: The patient's history of H. pylori and symptoms of epigastric abdominal pain, nausea, and diarrhea are consistent with a recurrence of the infection. The crampy nature of the pain and worsening at night also support this diagnosis.
- Other Likely diagnoses
- Gastroesophageal reflux disease (GERD): The patient's epigastric pain and worsening symptoms with eating could be indicative of GERD.
- Viral gastroenteritis: The patient's symptoms of diarrhea, nausea, and fever could be consistent with a viral gastroenteritis.
- Irritable bowel syndrome (IBS): The patient's abdominal pain, diarrhea, and crampy nature of the pain could be indicative of IBS.
- Do Not Miss
- Peptic ulcer disease: Although the patient has a history of H. pylori, a peptic ulcer could still be present and cause significant morbidity if not treated promptly.
- Appendicitis: Although the patient's pain is epigastric, appendicitis can sometimes present with atypical symptoms and should be considered, especially with the presence of fever.
- Pancreatitis: The patient's epigastric pain and worsening symptoms with eating could be indicative of pancreatitis, which would require prompt medical attention.
- Rare diagnoses
- Gastric cancer: Although rare, gastric cancer could present with similar symptoms, especially in a patient with a history of H. pylori.
- Inflammatory bowel disease (IBD): The patient's symptoms of diarrhea, abdominal pain, and fever could be consistent with IBD, although it would be less likely given the acute onset of symptoms.