Heartburn differential diagnosis: Difference between revisions

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VisualWikitext

Latest revision as of 17:42, 17 September 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: José Eduardo Riceto Loyola Junior, M.D.[2]

Overview

Heartburn must be differentiated from other diseases that cause chest pain, such as acute coronary syndromes.
Heartburn may also be differentiated from other diseases that cause dysphagia such as esophageal cancer, achalasia and eosinophilic esophagitis in high risk individuals.

Differentiating Heartburn from other Diseases

Heartburn must be differentiated from other diseases that cause chest pain, such as acute coronary syndromes.
Heartburn may also be differentiated from other diseases that cause dysphagia in high risk individuals.
Cardiac causes must be excluded since they can be life-threatening and may present with similar symptoms. In order to facilitate this, there's a table below which describes the life-threatening causes which must be differentiated:

Differentiating heartburn from angina ^[1] ^[2]
Heartburn (GERD)	Angina or Heart Attack
Burning chest pain, begins at the breastbone	Tightness, pressure, squeezing, stabbing or dull pain, most often in the center
Pain that radiates towards the throat	Pain radiates to the shoulders, neck or arms
Sensation of food coming back to the mouth	Irregular or rapid heartbeat
Acid taste in the back of the throat	Cold sweat or clammy skin
Pain worsens when patient lie down or bend over	Lightheadedness, weakness, dizziness, nausea, indigestion or vomiting
Appears after large or spicy meal	Shortness of breath
	Symptoms appears with physical exertion or extreme stress

While evaluating heartburn and considering gastroesophageal reflux disease (GERD) its most probable diagnosis, there's a diagnostic approach that must be performed in order to exclude other causes, especially in high risk patients, according the the American Journal of Gastroenterology guidelines^[3] :

Classic symptoms of GERD
(heartburn and regurgitation)

If there are warning signs*:
upper endoscopy during the initial evaluation

PPI 8-week trial

If better: GERD probable

If refractory, proceed to refractory GERD algorithm

Dysphagia, bleeding, anemia, weight loss and recurrent vomiting are considered warning signs and should be investigated with upper endoscopy. Esophageal cancer, and other severe diseases including esophagitis may be considered, the latter especially in HIV patients.

Treat GERD:
Start a 8-week course of PPI

If there are warning signs*:
upper endoscopy during the initial evaluation

Refractory GERD

Optimize PPI therapy

No response:
Exclude other etiologies

Typical symptoms:
Upper endoscopy

Atypical symptoms:
Referral to ENT, pulmonary, allergy specialist

Abnormal:
(eosinophilic esophagitis, erosive esophagitis, other)
Specific treatment

NORMAL

Abnormal:
(ENT, pulmonary, or allergic disorder)
Specific treatment

REFLUX MONITORING

Low pre test probability of GERD

High pre test probability of GERD

Test off medication with pH or impedance-pH

Test on medication with impedance-pH

High Risk: Men >50 years with chronic gastroesophageal reflux disease symptoms (>5 years), AND:
- Nocturnal reflux symptoms
- Hiatal hernia
- Elevated body mass index
- Tobacco use
- Intra-abdominal distribution of fat
Heartburn must be differentiated from other diseases such as GERD, gastritis, peptic ulcer, crohn's disease, gastric adenocarcinoma, and gastrinoma.^[4]^[5]^[6]^[7]^[8]^[9]^[10]^[11]^[12]


Differential Diagnosis
Disease	Cause	Symptoms									Diagnosis	Other findings
		Pain			Nausea & Vomiting	Heartburn	Belching or Bloating	Weight loss	Loss of Appetite	Stools	Endoscopy findings
		Location	Aggravating Factors	Alleviating Factors	Nausea & Vomiting	Heartburn	Belching or Bloating	Weight loss	Loss of Appetite	Stools	Endoscopy findings
GERD	Lower esophageal sphincter abnormalities Hiatal hernia Abnormal esophageal contractions Prolonged emptying of stomach Gastrinomas	Epigastric pain	Spicy food Tight fitting clothing	Antacids Head elevation during sleep	✔ (Suspect delayed gastric emptying)	✔	-	-	-	-	Esophagitis Barrette's esophagus Strictures	Other symptoms: Dysphagia Regurgitation Nocturnal cough Hoarseness Complications Esophagitis Strictures Barrette esophagus
Acute gastritis	H. pylori NSAIDS Corticosteroids Alcohol Spicy food Viral infections Crohn's disease Autoimmune diseases Bile reflux Cocaine use Breathing machine or ventilator Ingestion of corrosives	Epigastric pain	Food	Antacids	✔	✔	✔	-	✔	Black stools	Pangastritis or antral gastritis Erosive (Superficial, deep, hemorrhagic) Nonerosive (H. pylori)	-
Chronic gastritis	H. pylori Alcohol Medications Autoimmune diseases Chronic stress	Epigastric pain	Food	Antacids	✔	✔	✔	✔	✔	-	H. pylori gastritis Atrophy Intestinal metaplasia Lymphocytic gastritis Enlarged folds Aphthoid erosions	-
Atrophic gastritis	H. pylori Autoimmune disease	Epigastric pain	-	-	✔	-		✔	✔	-	H. pylori Mucosal atrophy Autoimmune Mucosal atrophy	Iron deficiency anemia Autoimmune gastritis diagnosis includes: Antiparietal and anti-IF antibodies Achlorhydria and hypergastrinemia Low serum cobalamine
Crohn's disease	Autoimmune disease	Abdominal pain	-	-	-	-	-	✔	✔	Chronic diarrhea often bloody with pus or mucus Rectal bleeding	Mucosal nodularity with cobblestoning Multiple aphthous ulcers Linier or serpiginous ulcerations Thickened antral folds Antral narrowing Hypoperistalsis Duodenal strictures	Fever Fatigue Anemia (pernicious anemia)
Peptic ulcer disease	H. pylori Smoking Alcohol Radiation therapy Medications Zollinger-ellison syndrome	Epigastric pain sometimes extending to back Right upper quadrant pain	Duodenal ulcer Pain aggravates with empty stomach Gastric ulcer Pain aggravates with food	Antacids Duodenal ulcer Pain alleviates with food	✔	✔	-	-	-	Black stools	Gastric ulcers Discrete mucosal lesions with a punched-out smooth ulcer base with whitish fibrinoid base Most ulcers are at the junction of fundus and antrum 0.5-2.5cm Duodenal ulcers Well-demarcated break in the mucosa that may extend into the muscularis propria of the duodenum Found in the first part of duodenum <1cm	Other diagnostic tests Serum gastrin levels Secretin stimulation test Biopsy
Gastrinoma	Associated with MEN type 1	Abdominal pain	-	-	✔ (suspect gastric outlet obstruction)	✔	-	-	-	Black stools	Useful in collecting the tissue for biopsy	May present with symptoms of GERD or peptic ulcer disease Associated with MEN type 1 Diagnostic tests Serum gastrin levels Somatostatin receptor scintigraphy CT and MRI
Gastric Adenocarcinoma	H. pylori infection Smoked and salted food	Abdominal pain	-	-	✔	✔	✔	✔	✔	Black stools, or blood in stools	Esophagogastroduodenoscopy Multiple biopsies are taken to establish the diagnosis	Other symptoms Dysphagia Early satiety Frequent burping
Primary gastric lymphoma	H. pylori infection	Abdominal pain Chest pain	-	-	-	-	-	✔	-	-	Useful in collecting the tissue for biopsy	Other symptoms Painless swollen lymph nodes in neck and armpit Night sweats Fatigue Fever Cough or trouble breathing

References

↑ "Heartburn vs. heart attack - Harvard Health".
↑ Bösner S, Haasenritter J, Becker A, Hani MA, Keller H, Sönnichsen AC; et al. (2009). "Heartburn or angina? Differentiating gastrointestinal disease in primary care patients presenting with chest pain: a cross sectional diagnostic study". Int Arch Med. 2: 40. doi:10.1186/1755-7682-2-40. PMC 2799444. PMID 20003376.
↑ Katz PO, Gerson LB, Vela MF (2013). "Guidelines for the diagnosis and management of gastroesophageal reflux disease". Am J Gastroenterol. 108 (3): 308–28, quiz 329. doi:10.1038/ajg.2012.444. PMID 23419381.
↑ Sugimachi K, Inokuchi K, Kuwano H, Ooiwa T (1984). "Acute gastritis clinically classified in accordance with data from both upper GI series and endoscopy". Scand J Gastroenterol. 19 (1): 31–7. PMID 6710074.
↑ Sipponen P, Maaroos HI (2015). "Chronic gastritis". Scand J Gastroenterol. 50 (6): 657–67. doi:10.3109/00365521.2015.1019918. PMC 4673514. PMID 25901896.
↑ Sartor RB (2006). "Mechanisms of disease: pathogenesis of Crohn's disease and ulcerative colitis". Nat Clin Pract Gastroenterol Hepatol. 3 (7): 390–407. doi:10.1038/ncpgasthep0528. PMID 16819502.
↑ Sipponen P (1989). "Atrophic gastritis as a premalignant condition". Ann Med. 21 (4): 287–90. PMID 2789799.
↑ Badillo R, Francis D (2014). "Diagnosis and treatment of gastroesophageal reflux disease". World J Gastrointest Pharmacol Ther. 5 (3): 105–12. doi:10.4292/wjgpt.v5.i3.105. PMC 4133436. PMID 25133039.
↑ Ramakrishnan K, Salinas RC (2007). "Peptic ulcer disease". Am Fam Physician. 76 (7): 1005–12. PMID 17956071.
↑ Banasch M, Schmitz F (2007). "Diagnosis and treatment of gastrinoma in the era of proton pump inhibitors". Wien Klin Wochenschr. 119 (19–20): 573–8. doi:10.1007/s00508-007-0884-2. PMID 17985090.
↑ Dicken BJ, Bigam DL, Cass C, Mackey JR, Joy AA, Hamilton SM (2005). "Gastric adenocarcinoma: review and considerations for future directions". Ann Surg. 241 (1): 27–39. PMC 1356843. PMID 15621988.
↑ Ghimire P, Wu GY, Zhu L (2011). "Primary gastrointestinal lymphoma". World J Gastroenterol. 17 (6): 697–707. doi:10.3748/wjg.v17.i6.697. PMC 3042647. PMID 21390139.

[urlHeartburn_vs._heart_attack_-_Harvard_Health-1] "Heartburn vs. heart attack - Harvard Health".

[pmid20003376-2] Bösner S, Haasenritter J, Becker A, Hani MA, Keller H, Sönnichsen AC; et al. (2009). "Heartburn or angina? Differentiating gastrointestinal disease in primary care patients presenting with chest pain: a cross sectional diagnostic study". Int Arch Med. 2: 40. doi:10.1186/1755-7682-2-40. PMC 2799444. PMID 20003376.

[pmid23419381-3] Katz PO, Gerson LB, Vela MF (2013). "Guidelines for the diagnosis and management of gastroesophageal reflux disease". Am J Gastroenterol. 108 (3): 308–28, quiz 329. doi:10.1038/ajg.2012.444. PMID 23419381.

[pmid6710074-4] Sugimachi K, Inokuchi K, Kuwano H, Ooiwa T (1984). "Acute gastritis clinically classified in accordance with data from both upper GI series and endoscopy". Scand J Gastroenterol. 19 (1): 31–7. PMID 6710074.

[pmid25901896-5] Sipponen P, Maaroos HI (2015). "Chronic gastritis". Scand J Gastroenterol. 50 (6): 657–67. doi:10.3109/00365521.2015.1019918. PMC 4673514. PMID 25901896.

[pmid16819502-6] Sartor RB (2006). "Mechanisms of disease: pathogenesis of Crohn's disease and ulcerative colitis". Nat Clin Pract Gastroenterol Hepatol. 3 (7): 390–407. doi:10.1038/ncpgasthep0528. PMID 16819502.

[pmid2789799-7] Sipponen P (1989). "Atrophic gastritis as a premalignant condition". Ann Med. 21 (4): 287–90. PMID 2789799.

[pmid25133039-8] Badillo R, Francis D (2014). "Diagnosis and treatment of gastroesophageal reflux disease". World J Gastrointest Pharmacol Ther. 5 (3): 105–12. doi:10.4292/wjgpt.v5.i3.105. PMC 4133436. PMID 25133039.

[pmid17956071-9] Ramakrishnan K, Salinas RC (2007). "Peptic ulcer disease". Am Fam Physician. 76 (7): 1005–12. PMID 17956071.

[pmid17985090-10] Banasch M, Schmitz F (2007). "Diagnosis and treatment of gastrinoma in the era of proton pump inhibitors". Wien Klin Wochenschr. 119 (19–20): 573–8. doi:10.1007/s00508-007-0884-2. PMID 17985090.

[pmid15621988-11] Dicken BJ, Bigam DL, Cass C, Mackey JR, Joy AA, Hamilton SM (2005). "Gastric adenocarcinoma: review and considerations for future directions". Ann Surg. 241 (1): 27–39. PMC 1356843. PMID 15621988.

[pmid21390139-12] Ghimire P, Wu GY, Zhu L (2011). "Primary gastrointestinal lymphoma". World J Gastroenterol. 17 (6): 697–707. doi:10.3748/wjg.v17.i6.697. PMC 3042647. PMID 21390139.

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@@ Line 3: / Line 3: @@
 {{CMG}} {{AE}} {{Jose}}
+==Overview==
+[[Heartburn]] must be differentiated from other diseases that cause [[chest pain]], such as [[acute coronary syndromes]].<br>
+[[Heartburn]] may also be differentiated from other diseases that cause [[dysphagia]] such as [[esophageal cancer]], [[achalasia]] and [[eosinophilic esophagitis]] in high risk individuals.
 ==Differentiating Heartburn from other Diseases==
+*[[Heartburn]] must be differentiated from other diseases that cause [[chest pain]], such as [[acute coronary syndromes]].</br>
-[[Heartburn]] must be differentiated from other causes of [[chest pain]]. Cardiac causes must be excluded since they can be life-threatening and may present with similar symptoms. In order to facilitate this, there's a table below which describes the life-threatening causes which must be differentiated:
+*[[Heartburn]] may also be differentiated from other diseases that cause [[dysphagia]] in high risk individuals.</br>
+*Cardiac causes must be excluded since they can be life-threatening and may present with similar symptoms. In order to facilitate this, there's a table below which describes the life-threatening causes which must be differentiated:
 </br>
 {| class="wikitable"
@@ Line 34: / Line 38: @@
 |}
 </br>
-While evaluating heartburn and considering [[gastroesophageal reflux disease]] ([[GERD]]) its most probable diagnosis, there's a diagnostic approach that must be performed in order to exclude other causes, especially in high risk patients:
+While evaluating heartburn and considering [[gastroesophageal reflux disease]] ([[GERD]]) its most probable diagnosis, there's a diagnostic approach that must be performed in order to exclude other causes, especially in high risk patients, according the the American Journal of Gastroenterology guidelines<ref name="pmid23419381">{{cite journal| author=Katz PO, Gerson LB, Vela MF| title=Guidelines for the diagnosis and management of gastroesophageal reflux disease. | journal=Am J Gastroenterol | year= 2013 | volume= 108 | issue= 3 | pages= 308-28; quiz 329 | pmid=23419381 | doi=10.1038/ajg.2012.444 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23419381  }} </ref> :
+</br>
 </br>
 {{familytree/start |summary=PE diagnosis Algorithm.}} {{familytree | | | | A01 |~| A02 | A01='''Classic symptoms of GERD''' <br>(heartburn and regurgitation)|A02= If there are '''warning [[signs]]*''':<br> upper [[endoscopy]] during the initial evaluation}}
@@ Line 42: / Line 47: @@
 {{familytree | | C01 | | C02 | C01= If better: [[GERD]] probable| C02= If refractory, proceed to refractory [[GERD]] algorithm}}
 {{familytree/end}}
-<nowiki>*</nowiki> [[Dysphagia]], [[bleeding]], [[anemia]], [[weight loss]] and recurrent [[vomiting]] are considered warning signs and should be investigated with [[upper endoscopy]].
+*[[Dysphagia]], [[bleeding]], [[anemia]], [[weight loss]] and recurrent [[vomiting]] are considered warning signs and should be investigated with [[upper endoscopy]]. [[Esophageal cancer]], and other severe diseases including [[esophagitis]] may be considered, the latter especially in [[HIV]] patients.<br>
+<br>
 {{familytree/start}}
@@ Line 70: / Line 76: @@
 **[[Tobacco]] use
 **Intra-abdominal distribution of fat
-</br>
+* Heartburn must be differentiated from other diseases such as [[GERD]], [[gastritis]], [[peptic ulcer]], [[crohn's disease]], [[gastric adenocarcinoma]], and [[gastrinoma]].<ref name="pmid6710074">{{cite journal| author=Sugimachi K, Inokuchi K, Kuwano H, Ooiwa T| title=Acute gastritis clinically classified in accordance with data from both upper GI series and endoscopy. | journal=Scand J Gastroenterol | year= 1984 | volume= 19 | issue= 1 | pages= 31-7 | pmid=6710074 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6710074  }} </ref><ref name="pmid25901896">{{cite journal| author=Sipponen P, Maaroos HI| title=Chronic gastritis. | journal=Scand J Gastroenterol | year= 2015 | volume= 50 | issue= 6 | pages= 657-67 | pmid=25901896 | doi=10.3109/00365521.2015.1019918 | pmc=4673514 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25901896  }} </ref><ref name="pmid16819502">{{cite journal| author=Sartor RB| title=Mechanisms of disease: pathogenesis of Crohn's disease and ulcerative colitis. | journal=Nat Clin Pract Gastroenterol Hepatol | year= 2006 | volume= 3 | issue= 7 | pages= 390-407 | pmid=16819502 | doi=10.1038/ncpgasthep0528 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16819502  }} </ref><ref name="pmid2789799">{{cite journal| author=Sipponen P| title=Atrophic gastritis as a premalignant condition. | journal=Ann Med | year= 1989 | volume= 21 | issue= 4 | pages= 287-90 | pmid=2789799 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2789799  }} </ref><ref name="pmid25133039">{{cite journal| author=Badillo R, Francis D| title=Diagnosis and treatment of gastroesophageal reflux disease. | journal=World J Gastrointest Pharmacol Ther | year= 2014 | volume= 5 | issue= 3 | pages= 105-12 | pmid=25133039 | doi=10.4292/wjgpt.v5.i3.105 | pmc=4133436 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25133039  }} </ref><ref name="pmid17956071">{{cite journal| author=Ramakrishnan K, Salinas RC| title=Peptic ulcer disease. | journal=Am Fam Physician | year= 2007 | volume= 76 | issue= 7 | pages= 1005-12 | pmid=17956071 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17956071  }} </ref><ref name="pmid17985090">{{cite journal| author=Banasch M, Schmitz F| title=Diagnosis and treatment of gastrinoma in the era of proton pump inhibitors. | journal=Wien Klin Wochenschr | year= 2007 | volume= 119 | issue= 19-20 | pages= 573-8 | pmid=17985090 | doi=10.1007/s00508-007-0884-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17985090  }} </ref><ref name="pmid15621988">{{cite journal| author=Dicken BJ, Bigam DL, Cass C, Mackey JR, Joy AA, Hamilton SM| title=Gastric adenocarcinoma: review and considerations for future directions. | journal=Ann Surg | year= 2005 | volume= 241 | issue= 1 | pages= 27-39 | pmid=15621988 | doi= | pmc=1356843 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15621988  }} </ref><ref name="pmid21390139">{{cite journal| author=Ghimire P, Wu GY, Zhu L| title=Primary gastrointestinal lymphoma. | journal=World J Gastroenterol | year= 2011 | volume= 17 | issue= 6 | pages= 697-707 | pmid=21390139 | doi=10.3748/wjg.v17.i6.697 | pmc=3042647 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21390139  }} </ref>
-Other causes of heartburn or similar symptoms / associated causes:
-* [[Asthma]]
-* [[Barrett's esophagus]]
-* [[Cardiotomy]]
-* Caustic agent ingestion with resultant mucosal injury
-* [[Chagas disease]]
-* [[Cholelithiasis]]
-* [[Coronary artery disease]]
-* [[Coughing]]
-* [[CREST syndrome]] (Calcinosis Raynaud's phenomenon Esophagus Sclerodactyly Telangiectasias)
-* Direct irritation of esophagus:
-**[[Aspirin]]
-**[[Cigarette smoke]]
-**Citrus fruits, juice
-**[[Ibuprofen]]
-**Spicy foods
-**Tomatoes
-**Tomato sauces
-* [[Drugs]]:
-**[[Albuterol]]
-**[[Anticholinergic]]s
-**[[Caffeine]]
-**[[Calcium channel blockers]]
-**[[Cigarette smoking]]
-**[[Nitrates]]
-**[[Progesterone]]
-**[[Theophylline]]
-* Esophageal fistula
+{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
-* [[Esophageal carcinoma]]
+| colspan="13" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''Differential Diagnosis'''}}
-* [[Esophageal diverticulum]]
+|+
+| rowspan="3" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Disease'''}}
+| rowspan="3" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Cause'''}}
+| colspan="9" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Symptoms'''}}
+| style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Diagnosis'''}}
+| rowspan="3" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Other findings'''}}
+|-
+| colspan="3" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Pain'''}}
+| rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Nausea & Vomiting'''}}
+| rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Heartburn'''}}
+| rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Belching or Bloating'''}}
+| rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Weight loss'''}}
+| rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Loss of Appetite'''}}
+| rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Stools'''}}
+| rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Endoscopy findings'''}}
+|-
+| rowspan="1" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Location'''}}
+| rowspan="1" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Aggravating Factors'''}}
+| rowspan="1" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Alleviating Factors'''}}
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |[[GERD]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* Lower esophageal sphincter abnormalities
+* [[Hiatal hernia]]
+* Abnormal esophageal contractions
+* Prolonged emptying of [[stomach]]
+* [[Gastrinomas]]
+|
+* [[Epigastric pain]]
+|
+* Spicy food
+* Tight fitting clothing
+|
+* [[Antacids]]
+* Head elevation during sleep
+|✔
-* Foods:
+(Suspect delayed gastric emptying)
-**[[Alcohol]]
+|✔
-**Chocolate
+|<nowiki>-</nowiki>
-**Coffee
+|<nowiki>-</nowiki>
-**Fatty foods
+|<nowiki>-</nowiki>
-**Peppermint
+|<nowiki>-</nowiki>
-**Soft drinks with caffeine
+|
-**Tea
+* [[Esophagitis]]
+* [[Barrette's esophagus]]
+* [[Strictures]]
+|Other symptoms:
+* [[Dysphagia]]
+* [[Regurgitation]]
+* [[Cough|Nocturnal cough]]
+* [[Hoarseness]]
+Complications
+* [[Esophagitis]]
+* [[Strictures]]
+* Barrette esophagus
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |[[Acute gastritis]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* ''[[H. pylori]]''
+* [[NSAIDS]]
+* [[Corticosteroids]]
+* [[Alcohol]]
+* Spicy food
+* Viral infections
+* [[Crohn's disease]]
+* [[Autoimmune diseases]]
+* Bile reflux
+* [[Cocaine]] use
+* Breathing machine or ventilator
+* Ingestion of [[corrosive|corrosives]]
+|
+* [[Epigastric pain]]
+|Food
+|[[Antacids]]
+|✔
+|✔
+|✔
+|<nowiki>-</nowiki>
+|✔
+|[[Melena|Black stools]]
+|
+* [[Pangastritis]] or antral [[gastritis]]
+* [[Gastric erosion|Erosive]] (Superficial, deep, hemorrhagic)
+* Nonerosive (''[[H. pylori]]'')
+|<nowiki>-</nowiki>
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |[[Gastritis|Chronic gastritis]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* ''[[H. pylori]]''
+* [[Alcohol]]
+* Medications
+* [[Autoimmune diseases]]
+* Chronic stress
+|
+* [[Epigastric pain]]
+|Food
+|[[Antacids]]
+|✔
+|✔
+|✔
+|✔
+|✔
+|<nowiki>-</nowiki>
+|''[[H. pylori]] [[gastritis]]''
+* [[Atrophy]]
+* Intestinal [[metaplasia]]
+Lymphocytic gastritis
+* Enlarged folds
+* Aphthoid erosions
+|<nowiki>-</nowiki>
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |[[Atrophic gastritis]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* ''[[H. pylori]]''
+* [[Autoimmune disease]]
+|[[Epigastric pain]]
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|✔
+|<nowiki>-</nowiki>
+|
+|✔
+|✔
+|<nowiki>-</nowiki>
+|''[[H. pylori]]''
+* Mucosal [[atrophy]]
+[[Autoimmune]]
+* Mucosal [[atrophy]]
+|
+* [[Iron deficiency anemia]]
+*Autoimmune gastritis diagnosis includes:
+**Antiparietal and anti-IF antibodies
+**[[Achlorhydria]] and hypergastrinemia
+**Low serum [[vitamin B12|cobalamine]]
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |[[Crohn's disease]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* [[Autoimmune disease]]
+|
+* [[Abdominal pain]]
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|✔
+|✔
+|
+* Chronic [[diarrhea]] often bloody with [[pus]] or [[mucus]]
+* [[Rectal bleeding]]
+|
+* Mucosal nodularity with cobblestoning
+* Multiple [[aphthous ulcers]]
+* Linier or serpiginous ulcerations
+* Thickened antral folds
+* Antral narrowing
+* Hypoperistalsis
+* Duodenal strictures
+|
+* [[Fever]]
+* [[Fatigue]]
+* [[Anemia]] ([[pernicious anemia]])
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |[[Peptic ulcer disease]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* ''[[H. pylori]]''
+* [[Smoking]]
+* [[Alcohol]]
+* [[Radiation therapy]]
+* Medications
+* Zollinger-ellison syndrome
+|
+* [[Epigastric pain]] sometimes extending to back
+* [[Right upper quadrant pain]]
+|
+'''[[Duodenal ulcer]]'''
+*Pain aggravates with empty stomach
+'''[[Gastric ulcer]]'''
+*Pain aggravates with food
+|
+* [[Antacids]]
-* Fundectomy (postoperative)
+* [[Duodenal ulcer]]
-* [[Gastrectomy]] (postoperative)
+:*Pain alleviates with food
-* [[Gastritis]]
+|✔
-* [[Gastroesophageal reflux disease]] ([[GERD]])
+|✔
-* [[Hiatal hernia]]
+|<nowiki>-</nowiki>
-* Infectious [[esophagitis]]
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|
+* [[Melena|Black stools]]
+|'''Gastric ulcers'''
+* Discrete mucosal lesions with a punched-out smooth ulcer base with whitish fibrinoid base
+* Most [[ulcers]] are at the junction of [[fundus]] and antrum
+* 0.5-2.5cm
+'''Duodenal ulcers'''
+* Well-demarcated break in the [[mucosa]] that may extend into the [[muscularis propria]] of the [[duodenum]]
+* Found in the first part of [[duodenum]]
+* <1cm
+|'''Other diagnostic tests'''
+* Serum [[gastrin]] levels
+* [[Secretin]] stimulation test
+* [[Biopsy]]
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |[[Gastrinoma]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* Associated with [[MEN type 1]]
+|
+* [[Abdominal pain]]
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|✔
-* [[Mallory-Weiss tear]]
+(suspect [[gastric outlet obstruction]])
-* Motility disorders
+|✔
-* [[Myasthenia gravis]]
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
-* [[Peptic ulcer disease]]
+|<nowiki>-</nowiki>
-* [[Pericardial disease]]
+|
-* [[Pregnancy]]
+* [[Melena|Black stools]]
-* [[Pulmonary embolism]]
+|Useful in collecting the tissue for [[biopsy]]
-* [[Scleroderma]]
+|
-* Strictures, webs or rings
+* May present with symptoms of [[GERD]] or [[peptic ulcer disease]]
-* [[Vagotomy]] (postoperative)
+* Associated with [[MEN type 1]]
+'''Diagnostic tests'''
+* Serum [[gastrin]] levels
+* [[Somatostatin]] receptor [[scintigraphy]]
+* [[CT]] and [[MRI]]
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |[[Gastric Cancer|Gastric Adenocarcinoma]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* ''[[H. pylori]]'' infection
+* Smoked and salted food
+|
+* [[Abdominal pain]]
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|✔
+|✔
+|✔
+|✔
+|✔
+|
+* [[Melena|Black stools]], or blood in stools
+|'''Esophagogastroduodenoscopy'''
+* Multiple biopsies are taken to establish the diagnosis
+|'''Other symptoms'''
+* [[Dysphagia]]
+* Early [[satiety]]
+* Frequent [[burping]]
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |[[Gastric lymphoma|Primary gastric lymphoma]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* ''[[H. pylori]]'' infection
+|
+* [[Abdominal pain]]
+* [[Chest pain]]
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|✔
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|Useful in collecting the tissue for [[biopsy]]
+|'''Other symptoms'''
+* Painless swollen [[lymph nodes]] in neck and armpit
+* Night sweats
+* [[Fatigue]]
+* [[Fever]]
+* [[Cough]] or trouble breathing
+|}
 ==References==
 {{Reflist|2}}
-{{WH}}
-{{WS}}
 [[Category:General practice]]
 [[Category:Gastroenterology]]
 [[Category:Digestive disease symptoms]]
-[[Category:Needs overview]]

Heartburn differential diagnosis: Difference between revisions

Latest revision as of 17:42, 17 September 2020

Overview

Differentiating Heartburn from other Diseases

References

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