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Can acid reflux cause swelling of submandibular and cervical

Resolved Question:

Can acid reflux cause swelling of submandibular and cervical lymph nodes if there is inflammation in the throat?

I noticed I had one swollen gland in the submandibular region. I went to the ENT, who said it might just be an infection. He ordered an ultrasound and these are the measurements:

RT SM TS: 1.78cm x 1.05cm
RT SM LS ROI: 2.06cm x 1.07cm
LT UPP CERVICAL LS: 1.97cm x .775cm & 1.49cm x .509cm
RT UPP CERVICAL LS: 1.96cm x .726cm

The radiologist's report says "The sympomatic area is located around the angle of right mandible. There is a nodular lesion with echopattern suggestive of lymph node found underlying the symptomatic area. It is not within the right parotid gland or submandibular gland. It is suggestive of an enlarged lymph node. Similar but smaller lymph nodes are found on the left side. They are suggestive of possible reactive inflammatory lymph nodes."

I have had this for 3 weeks now. I've been trying to eat better and sleep better just in case it's an infection. But is it possible at all that mild acid reflux can cause this? Timeline:

4 weeks ago: feel a lump in throat sensation which doctor thinks is stress related. 4-5 days later lump sensation still persists and then I can feel one lymph node (the submandibular one) swell

3 weeks ago: lump in throat sensation is on and off

2 weeks ago: notice a slight sore throat and also tried taking pepcid and nexium since I suspected reflux.

1 week ago: bad reflux. I think nexium actually made it worse because I had heartburn for the first time after eating a lot of food. Burning from my stomach to chest to throat and nausea. Went away after an hour or so.

This week: made some diet changes and noticed that bland dry foods help. And also if I take pepcid at least 45 mins before eating it stops the lump sensation from coming. I never have heartburn except for that one time.

So, can this be caused by reflux and if I get it under control can this cause the swelling to go down? I'm scared this might be lymphoma, but many doctors on here say that since the nodes are all pretty close in size it's not likely to be lymphoma. Also, the one I can feel isn't hard and it's definitely movable.

My reflux is very mild. I only have the lump sensation after eating something disagreeable. Sometimes a sore throat accompanies it but goes away after a few hours. I only had heartburn once and that was after I took nexium. Now I take pepcid twice a day and notice improvement in reflux. But the lymph node hasn't really gone done. Feels a tad smaller but still swollen
Submitted: 3 years ago.
Category: Medical
Expert:  Dr Mask replied 3 years ago.
Hello,

Welcome to Justanswer

Before I may go for the answer, a little explanation may help you to understand the situation better.

Lymph nodes are like out body's guard posts. When ever there is an infection in any particular area these swell up (increase in size = increase the strength of its recruits) to be able to fight the infection better.

Acid reflex should not directly cause the lymph nodes to swell however as the reflex causes the throat to be more prone to infection (by damaging the throat lining with the acidic pH of the gastric contents) thereby once there are repeated episodes of infections, yes the nodes can swell.

The pattern of the lymph node swelling is actually suggestive of a response to infection so no you do not need to be afraid for it to be leukemia.

However, if you have a strong family history then you can go for a basic test such as CBC (complete blood count) with ESR and that should give a hint.

To bring down the swelling you need to remove the cause to start with. i.e. prevent the acid reflex episodes by taking drugs to reduce the acidity (already being done by you), avoiding oily, spicy foods, sleeping with the head end slightly above the foot end and making sure that the difference between your dinner and sleep time is at least around 2 hours.

You may even need antibiotics for the sore throat (you may not feel it intensely but there may be a sub-acute infection of the throat going on) so it would be best to get examined by your ENT doctor once again.


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Dr MASK
Customer: replied 3 years ago.
Thanks. The ENT had used a mirror on a short rod to look at my throat and said there wasn't anything wrong, but I'm positive this is reflux. Is it possible he just couldn't see enough with the rod?
Expert:  Dr Mask replied 3 years ago.
That is called the indirect laryngoscope. It is a rod with a mirror at the end which he used in you to see if there was any physical obstruction in the throat area causing the feeling of the lump or if there was any damage to your vocal cords due to the acid reflex or any stricture formation in the throat due to the reflex.

So if he said there was nothing wrong then that means that there were no masses there and that there were no signs of acid reflex causing damage.

This can be when the acid reflex is infrequent and relatively new.

So this was basically a good news.

The swelling in the nodes can take a little time to subside once the cause (either sore throat secondary to an infection or reflex is controlled). The only thing that should get you worried is the increase in the number of affected lymph nodes or any increase in their size.

If you observe that then the best thing to do would be a lymph node biopsy.

But if that does not happen a few regular follow up visits say once a week or twice a week to your ENT should be ideally there till the resolution of this issue.

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Regards
Dr MASK
Customer: replied 3 years ago.
If the reflux continues though without treatment is it possible for more nodes to swell or for the current ones to increase in size? According to the ultrasound I have 5 swollen nodes, though only 1 is palpable.
Expert:  Dr Mask replied 3 years ago.
The nodes that can swell would be in the area similar to the present one on the opposite side provided the infection or inflammation occurs on the other side in the throat.

Yes with reflex not controlled that can happen.

But in such a situation (of an increase in lymph node numbers or size) we have to rule out the worse possibilities to be on the safe side.

So instead of thinking of it just as secondary to the reflex causing increased inflammation and/or infection in the throat leading to the lymph node swelling it would be best to get a CBC and a lymph node biopsy done.

And along side controlling the reflex it would be helpful to have a prophylactic course of an antibiotic like amoxacillin.

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Regards
Dr MASK
Dr Mask, Doctor
Category: Medical
Satisfied Customers: 1435
Experience: MBBS with 06 years Clinical Exposure in Surgery & Internal Medicine
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Customer: replied 3 years ago.
Okay thank you for your answers. What are the chances that this is cancerous? I don't have any other symptoms except sometimes if I don't get enough sleep (<6 hrs) I'll feel like a cold is coming on. If I nap even for just 45 minutes it goes away completely.

Expert:  Dr Mask replied 3 years ago.
One can not, with accuracy, say that its a 100 % chances for these lymph nodes to be or not to be cancerous.

That definitely can not be considered as a symptom for cancer (leukemia/lymphoma to be specific).

Usual symptoms are fevers, Bone and joint pains, Weight loss, decrease in appetite, bleeding and bruising easily.

So till now this really does not sound like a lymphoma or a leukemia.

Hope This Helps

Regards
Dr MASK
Dr Mask, Doctor
Category: Medical
Satisfied Customers: 1435
Experience: MBBS with 06 years Clinical Exposure in Surgery & Internal Medicine
Dr Mask and 6 other Medical Specialists are ready to help you
Customer: replied 3 years ago.
Okay. "til now" as in the cold symptom is a lymphoma or leukemia symptom or is not?
Expert:  Dr Mask replied 3 years ago.
No, that is not a symptom of lymphoma or leukemia. Its simply a sign that you need to rest a bit and when you do it goes away.

So try not to panic and follow a simple plan, i.e. Observe the size and the no of lymph nodes palpable. If either the size or the number increases visit a doctor and get a CBC and a biopsy done.

Most probably these lymph nodes have increased in size due to the inflammation. Get an antibiotic course as prophylactic measures to help protect against any bacterial infection that can set in especially when the area is inflamed and hence more vulnerable to infection.

It does not seem the right thing for reasonable person like yourself to panic and besides that the ultrasound is also not painting the picture typical for cancerous lymph nodes.

So try and relax and approach this situation with a calm mind frame.

Hope This Helps

Best Wishes
Dr MASK
Dr Mask, Doctor
Category: Medical
Satisfied Customers: 1435
Experience: MBBS with 06 years Clinical Exposure in Surgery & Internal Medicine
Dr Mask and 6 other Medical Specialists are ready to help you
Customer: replied 3 years ago.
Thanks for being so down to earth with me. I think I may have an allergy to penicillin since my brother and mom are allergic to it.

Can diet alone help decrease the inflammation? Because I got nauseous today after taking a second 20mg pepcid after 4 hours of the first and am hesitant to take it again. I think I have a good grasp on what foods trigger the reflux now, so was going to go on that diet until my next appt, which is in 3 weeks.

Just a question about intermittent fatigue: sometimes after class or maybe after dinner, I'll feel kind of exhausted. But then maybe after a few minutes, I'll be wide awake again without sleeping. I know fatigue can be a symptom of leukemia, but is this random intermittent fatigue a symptom of i?
Expert:  Dr Mask replied 3 years ago.
You are welcome if you felt that way, but I was just being the way we take our oath to be.

In this situation 2 things would be vital

1. Remove the cause of inflammation i.e. decrease the acid reflex. This can done by taking drugs such as pepcid or a drug among more effective group of drugs called the proton pump inhibitors example being prilosec. So if you have an issue with pepcid you can go for prilosec an OTC drug.

2. Avoids foods and in this manner it may help

3. An antibiotic course as a prophylactic measure to avoid a bacterial infection. If you fear that pencillin may not be good for you then you can go for other antibiotics like Azithromycin 500 mg once day for day 1 and then 250 mg day 2 on wards to day 5 but for that you would need a prescription.

Now the intermittent fatigue: Intermittent fatigue alone can not be taken as a sign of malignancy. Besides that people with malignancy have a continuous feeling of fatigue because of 2 reasons

1. Increased usage of the body's reserves by the malignant tissue
2. Decreased food intake due to decreased appetite secondary to the chemical markers from the malignancy effecting our hunger center in the brain.

In your case it only seems as lack of sleep, over burdened work schedule or a lack of vitamins. In your case the best thing would be regularly scheduled diet intake along with some good intake of fruits for vitamins and a sleep of at least 6 hours.

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Regards
Dr MASK
Dr Mask, Doctor
Category: Medical
Satisfied Customers: 1435
Experience: MBBS with 06 years Clinical Exposure in Surgery & Internal Medicine
Dr Mask and 6 other Medical Specialists are ready to help you
Customer: replied 3 years ago.
Hi, I just have a follow up question. How long should it take 20mg of famotidine twice daily to start actually working? I've been taking it intermittently but it isn't really helping.

I have a generic store brand famotidine from Hong Kong (living there right now) and I think it may have made me nauseous. I only used it twice so far (the other times I used it were on doctor's prescription and it was called pepcidine) but I noticed some nausea after I took it. I NEVER had this problem when taking famotidine in the U.S. or when taking the pepcidine prescribed by a doctor here

Is it possible the store brand is making me nauseous, or is it reflux making me nauseous? I definitely have an appetite, but sometimes either after eating or, as was the case yesterday, when about to eat dinner I get nauseous and just lose my appetite.
Expert:  Dr Mask replied 3 years ago.
Its very kind of you to have considered me for further help on the issue.

Yes, you are right about this possibility. Since a medication when available in oral form contains not only the drug but another compound called the excipient which is there for the stability of the drug and certain other characteristics, so this excipient can differ and as a result you may have had the nausea due to both the excipient and also due the possibility for the drug itself to cause that issue.

The drug being not able to help you control the acidity means you need to move on to the newer and better drug group for the same issue which is called the proton pump inhibitors.

The one you are already using belongs to the group called the H2 receptor blockers.

some of the common Examples for Proton pump inhibitor are Omeprazole, Esomeprazole and pantoprazole. Dosage you can begin with should be 40 mg 20 to 30 minutes before dinner or Esomeprazole at the same dosage or pantoprazole at the same dosage.

Hope This Helps

Regards
Dr MASK
Customer: replied 3 years ago.
I have Nexium (esomeprazole) 20mg. Is it okay to do just 20mg In the morning about half hour before eating breakfast? I only have 20mg tablets. Will that be enough?
Expert:  Dr Mask replied 3 years ago.
Yes that should do the trick.

Usually when a patient is asked to go for proton pump inhibitors 20 mg strength is advised however since you have been previously on H2 receptor blocker and that was not working so i thought it appropriate for you to start at step 2 (40 m once a day) instead of step 1 (20 mg once a day).

And the reason why it is preferable to take before dinner instead of the breakfast is the fact that people with acid reflex have the issue more at night than at day time since they are lying down at night.


But yes you can take in the morning and there is no contraindication to it being used the morning.

Hope This Helps

Regards
Dr MASK
Dr Mask, Doctor
Category: Medical
Satisfied Customers: 1435
Experience: MBBS with 06 years Clinical Exposure in Surgery & Internal Medicine
Dr Mask and 6 other Medical Specialists are ready to help you
Customer: replied 3 years ago.
I woke up this morning with what I'm pretty sure is a cold. I have a bad sore throat, some minor chills, and I just don't really feel like going out.

in light of the swollen lymph nodes, should this be concerning or is it maybe the CAUSE to begin with?
Expert:  Dr Mask replied 3 years ago.
Welcome back.

The swollen lymph nodes have been there due to the fact that you have an ongoing acid reflex causing the sub acute inflammation going on in the throat.

This causes the throat to be more prone to infection since the immune system is already engaged due to ongoing inflammation.

Sine there is no fever and only sore throat so this does not look like a bacterial infection. Still it would be recommended for you to go for prophylactic use (use of an antibiotic before the infection in circumstances highly likely to cause bacterial infection) of an antibiotic. Antibiotic like amoxicillin at 500 mg twice a day for 5 days or Lvofloxacin 500 mg once a day for 5 days should do the trick.

Besides that you can use steam inhalation twice a day along with some lozenges (e.g being strepsils which is available in hongkong)

Hope This Helped

Regards
Dr MASK
Customer: replied 3 years ago.
I was going to start taking Nexium this week but since I'm sick, I'm not sure if I should. I'm currently taking Tylencol cold for my symptoms. Is it okay to take Nexium on top of this?
Expert:  Dr Mask replied 3 years ago.
Yes, there is no contraindication for nexium to be taken with tylenol or with symptoms of cold.

In fact, since tylenol contains paracetamol an NSAID (Non-steroidal anti inflammatory drugs) since carries the potential to cause gastritis (inflammation of the stomach) where a drug, such as a proton pump inhibitor, would be an excellent thing to take. And it is actually a practice to add proton pump inhibitors when advising NSAIDS that commonly likely to cause gastritis.


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Regards
Dr MASK

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