Epigastric Pain Differential Diagnosis
The differential diagnosis for epigastric pain can be organized into the following categories:
- Single Most Likely Diagnosis
- Gastroesophageal reflux disease (GERD): This is often the most common cause of epigastric pain due to the high prevalence of GERD in the general population. Symptoms such as heartburn and regurgitation, especially after eating or at night, support this diagnosis.
- Other Likely Diagnoses
- Peptic ulcer disease (PUD): Both gastric and duodenal ulcers can cause epigastric pain, often described as burning or gnawing, and can be related to food intake.
- Functional dyspepsia: This condition, also known as non-ulcer dyspepsia or indigestion, is characterized by recurring signs and symptoms of indigestion that have no obvious cause.
- Gallbladder disease (cholecystitis or cholelithiasis): While gallbladder disease typically causes right upper quadrant pain, it can sometimes radiate to the epigastrium.
- Do Not Miss Diagnoses
- Myocardial infarction: Although chest pain is the hallmark of myocardial infarction, some patients, especially women and diabetics, may present with epigastric pain, making it crucial not to miss this potentially fatal condition.
- Pancreatitis: Acute pancreatitis can cause severe, persistent epigastric pain that radiates to the back, and missing this diagnosis can lead to serious complications.
- Aortic dissection: This is a medical emergency where the inner layer of the aorta tears, and while it typically presents with severe back or chest pain, epigastric pain can be a part of the presentation, especially if the dissection involves the descending aorta.
- Rare Diagnoses
- Gastric cancer: Although rare, especially in younger populations, gastric cancer can cause epigastric pain and should be considered, especially in patients with risk factors such as a family history or certain dietary habits.
- Esophageal cancer: Similar to gastric cancer, esophageal cancer is rare but can cause epigastric pain, especially if the tumor is located in the lower esophagus.
- Splenic infarction or rupture: These conditions can cause severe left upper quadrant pain that may radiate to the epigastrium and are more likely in patients with certain risk factors, such as sickle cell disease or trauma.