Differential Diagnosis for Epigastric Pain and Vomit
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): This is a common condition characterized by the reflux of stomach acid into the esophagus, causing epigastric pain and vomiting. The symptoms are often exacerbated by eating, lying down, or consuming certain foods.
Other Likely Diagnoses
- Peptic Ulcer Disease: This includes both gastric and duodenal ulcers, which can cause epigastric pain and vomiting due to the erosion of the stomach or duodenal lining.
- Gastritis: Inflammation of the stomach lining can lead to epigastric pain and vomiting, often triggered by alcohol, NSAIDs, or stress.
- Food Poisoning: Consuming contaminated food can lead to acute onset of epigastric pain and vomiting.
- Viral Gastroenteritis: Infections like norovirus can cause epigastric pain, vomiting, and diarrhea.
Do Not Miss Diagnoses
- Myocardial Infarction: Although less common, myocardial infarction can present with epigastric pain and vomiting, especially in women or diabetic patients, and is a medical emergency.
- Pancreatitis: Inflammation of the pancreas can cause severe epigastric pain radiating to the back and vomiting, requiring prompt medical attention.
- Cholecystitis: Inflammation of the gallbladder can cause right upper quadrant pain, but sometimes the pain can be more epigastric, especially if the gallbladder is inflamed and distended.
- Pulmonary Embolism: Although rare, pulmonary embolism can present with sudden onset of chest pain and vomiting, and is a life-threatening condition.
Rare Diagnoses
- Zollinger-Ellison Syndrome: A rare condition characterized by excessive gastric acid production due to a gastrin-producing tumor, leading to severe peptic ulcers and diarrhea.
- Eosinophilic Esophagitis: A chronic inflammatory condition of the esophagus that can cause epigastric pain, vomiting, and difficulty swallowing, often associated with atopic diseases.
- Gastric Cancer: Although rare, gastric cancer can present with epigastric pain, vomiting, and weight loss, and should be considered in patients with risk factors or persistent symptoms.