I have been experiencing swelling and edema, especially in my abdominal area and legs and feet, for 10 years. Is edema ever related to a digestive disorder? Most everything else has been ruled out in my case.

W.J.

Edema (abnormal swelling) can be caused by a large variety of disorders. These conditions can be divided into two broad categories: high pressure causing enlargement and leakage of veins, and low protein in veins causing fluid to seep out.

In the first category, high pressure, common conditions include heart failure and kidney failure. In these conditions, there is an abnormally large amount of fluid in the body and veins, and edema develops, especially in the legs. Gastrointestinal conditions that can lead to high venous pressure, especially in the lower body, include an abdominal tumor or mass that compresses the veins in the abdomen. This could also occur with an ovarian tumor. It would be unlikely that such a condition would persist for 10 years without being detected.

In the second category, low protein in the veins, two general possibilities exist: failure of the body to produce protein and loss of protein. Since the liver produces most of the body's protein, severe liver disease (cirrhosis) can lead to low protein and edema. Edema is actually a common problem in cirrhotic patients and requires restricting salt intake, as well as the use of diuretics. Again, it is unlikely that this diagnosis would have been missed for a decade.

Loss of protein can occur into the urine (via the kidneys) or into the bowels (via the small intestine). With kidney disease, a failure to absorb protein can occur before the occurrence of kidney failure. This diagnosis is made on laboratory examination of the urine for protein. Loss of protein into the bowels may be more subtle. This is a less common cause of low protein, and the tests for protein in the stool are more difficult to perform by certain labs. Conditions leading to intestinal protein loss (known as protein-losing enteropathy) include sprue, lupus, certain parasites, lymphoma, Crohn's disease and certain intestinal complications of AIDS, just to name a few.

Since you have had edema for 10 years without an obvious cause being found, you've probably had an exhaustive work-up with many tests performed. You should discuss your work-up with your doctors to make sure that all the possibilities I've mentioned here have been considered.