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Have Nausea, Esophageal Tightness And Enlarged Spleen. History Of Duodenal Ulcers. Underlying Cause?

Posted on Wed, 20 Mar 2013

Question: Hello, I have had nausea, esophagus tightness (swallowing), fatigue, some swollen lymph nodes, and a slightly enlarged (12.8 cm) but sore spleen . Has been about 10 days. Blood tests were run 2 days ago and came back normal (full set of tests including mononucleosis and STDs). I am waiting on abdominal ultrasound results. I have a history of duodenal ulcers and acid reflux, although never had GERD symptoms (which I initially thought was the esophagus tightness). I currently have no stomach pain. Could an infected stomach ulcer be causing these gland and spleen enlargement? Can H Pylori do this? What else could it be given that my blood tests were all in range of normal? The lymph node on my left groin is large and painful - same side as the spleen. Thank you.

Answered by Dr. Polash Sannigrahi (1 hour later)

Hello XXXXXXX,

The causes of splenomegaly can be:
1. Infectious mononucleosis.
2. Splenic infiltration with cancer cells from a hematological malignancy.
3. Hemoglobinopathies
4. Portal hypertension (due to liver disease)

However, the presence of normal blood tests rules out the Hematological causes.
Under such condition, the presence of a liver pathology seems to be an etiological agent for all these symptoms.
Investigations such as Liver function test & Ultrasound scan of the abdomen will be helpful in clinching the diagnosis.

An infected stomach ulcer may also cause enlargement of these gland and spleen, but the absence of stomach pain rules out its possibilities.

H pylori infection can cause these symptoms & it can be detected by certain tests like blood antibody test, stool antigen test, or with the carbon urea breath test

So, it will be better to consult a Gastroenterologist & get a proper physical examination done.
So that appropriate management steps could be taken.

There is nothing to worry, you will be fine.

Wishing you a Good Health. Let me know if I need to clarify further.
Thanks & take care.

Above answer was peer-reviewed by : Dr. Aparna Kohli

Follow up: Dr. Polash Sannigrahi (2 hours later)

Thank you Doctor Sannigrahi, this is very helpful.

Is Lymphoma also a(n) (unlikely) possibility? My understanding is that regular blood screening tests often do not pick this up. Or possibly lymphoma would result in a very large spleen (ie 20 cm) and other symptoms not present?

One final question - are there lymphatic system components in the esophagus area that would cause the feeling of food stuck in the throat, such as GERD?

Thanks again.
XXXXXXX

Answered by Dr. Polash Sannigrahi (9 hours later)

Hello XXXXXXX,
Thanks for the review questions.

1. Though swelling of lymph nodes is a primary feature of Lymphoma, it is usually associated with a triad of symptoms:
A. Fever
B. Night sweats
C. Weight loss.
Since you are not having any of these symptoms, Lymphoma is not very likely.

And you are right...most cases of Lymphoma are associated with massive splenomegaly & sometimes routine blood screening may not be able to pick it up.
However, an FNAC (Fine Needle Aspiration Cytology) or Biopsy of the involved lymph node will be helpful in clinching the diagnosis.

2. There are lymphatic system components in the esophagus area such as MALT (mucosa-associated lymphoid tissue) & GALT (gut-associated lymphoid tissue).
Sometimes their chronic inflammation due to H pylori infection may result in MALT lymphoma that could cause the feeling of food stuck in the throat.
But there is nothing to worry.
It can be picked up by an Endoscopy & managed accordingly.

Hope I have been able to answer your queries.
Please let me know if you need further assistance.

Regards,
Dr. Polash Sannigrahi

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Above answer was peer-reviewed by : Dr. Prasad