Differential Diagnoses for Recurrent Lower Chest/Epigastric/Left Upper Quadrant Pain
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): This condition is characterized by stomach acid flowing back into the esophagus, causing pain and discomfort. The symptoms worsening at night, especially between 4 AM to 6 AM, and waking the patient from sleep are consistent with GERD, as lying down can exacerbate reflux.
Other Likely Diagnoses
- Peptic Ulcer Disease: Ulcers in the stomach or duodenum can cause epigastric pain that may radiate to the left upper quadrant or lower chest. The pain can be worse at night and may wake the patient from sleep, especially if the ulcer is bleeding or perforating.
- Functional Dyspepsia: This condition involves recurring signs and symptoms of indigestion that have no obvious cause. Symptoms can include pain or discomfort in the upper abdomen, which may be worse at night.
- Irritable Bowel Syndrome (IBS): Although IBS typically presents with abdominal pain associated with changes in bowel habits, some patients may experience upper abdominal or chest pain, especially if they have a predominant dyspeptic symptom profile.
Do Not Miss Diagnoses
- Myocardial Infarction (MI) or Acute Coronary Syndrome: Chest pain that wakes a patient from sleep, especially if it occurs between 4 AM to 6 AM, could be a sign of an MI or acute coronary syndrome. Although the pain is described as epigastric or left upper quadrant, cardiac causes must be considered due to the potential for fatal outcomes if missed.
- Pulmonary Embolism: Sudden onset of chest pain that worsens with deep breathing or movement could indicate a pulmonary embolism, a potentially life-threatening condition.
- Aortic Dissection: Severe, tearing chest pain that radiates to the back can be a sign of an aortic dissection, which is a medical emergency.
Rare Diagnoses
- Pancreatitis: Inflammation of the pancreas can cause severe abdominal pain that radiates to the back, but it is less common for pancreatitis to present with pain that specifically wakes the patient from sleep between 4 AM to 6 AM.
- Splenic Infarction or Rupture: These conditions can cause left upper quadrant pain but are less common and usually associated with specific risk factors such as trauma, sickle cell disease, or antiphospholipid syndrome.
- Esophageal Spasm or Esophageal Rupture: These are rare conditions that can cause chest pain, but they are less likely to present with the specific timing and location described in the scenario.