Differential Diagnosis for Upper Abdomen/Lower Chest Pain
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): This condition is a common cause of intermittent chest and upper abdominal pain, especially when it occurs at night or early in the morning. The symptoms can be exacerbated by lying down, which may explain the timing of the pain between 4 and 6 AM.
Other Likely Diagnoses
- Peptic Ulcer Disease: Peptic ulcers can cause intermittent pain in the upper abdomen that may radiate to the lower chest. The pain is often worse at night and can be relieved by eating or taking antacids.
- Gallbladder Disease: Gallstones or cholecystitis can cause intermittent pain in the right upper quadrant of the abdomen that may radiate to the lower chest, especially after eating fatty foods.
- Functional Dyspepsia: This condition is characterized by recurring or persistent upper abdominal pain or discomfort that is not explained by other medical conditions.
Do Not Miss Diagnoses
- Myocardial Infarction (MI): Although less likely, MI should always be considered in the differential diagnosis of chest pain, even if it occurs at an atypical time or has an atypical presentation.
- Pulmonary Embolism (PE): PE is a life-threatening condition that can cause sudden onset of chest pain, especially if it occurs at rest or wakes the patient from sleep.
- Aortic Dissection: This is a rare but life-threatening condition that can cause severe, tearing chest pain that radiates to the back or abdomen.
Rare Diagnoses
- Pancreatitis: Acute or chronic pancreatitis can cause severe upper abdominal pain that radiates to the back or lower chest, although it is less likely to occur intermittently between 4 and 6 AM.
- Esophageal Spasm: This condition can cause intermittent chest pain that is often described as squeezing or tightening, although it is relatively rare.
- Hiatal Hernia: A large hiatal hernia can cause intermittent upper abdominal or lower chest pain, especially if it becomes incarcerated or strangulated.