Intended for healthcare professionals

Practice Practice Pointer

Investigating dysphagia in adults

BMJ 2022; 379 doi: https://doi.org/10.1136/bmj-2021-067347 (Published 17 October 2022) Cite this as: BMJ 2022;379:e067347
  1. AM Waters, specialist trainee in ear, nose, and throat surgery1,
  2. J Patterson, professor of speech and language therapy2,
  3. P Bhat, general practitione,
  4. r,3,
  5. AW Phillips, consultant oesophagogastric surgeon4 5
  1. 1Department of Otolaryngology, Freeman Hospital, Newcastle upon Tyne, UK
  2. 2School of Health Sciences, Institute of Population Heath, University of Liverpool, UK
  3. 3Rockwell Medical Centre, Thorpe Edge, Bradford, UK
  4. 4Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
  5. 5School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
  1. Correspondence to A Phillips awphillips{at}doctors.org.uk

What you need to know

  • New onset dysphagia in adults requires urgent direct access upper gastrointestinal endoscopy (to be done within two weeks); dysphagia associated with head and neck cancer red flags requires a suspected head and neck cancer pathway referral

  • In many cases malignancy is not found, but management of benign conditions, such as oesophageal dysmotility or gastro-oesophageal reflux, can be challenging

  • Secondary sequelae of benign and malignant dysphagia include malnutrition and aspiration pneumonia: consider early input from dietetic and speech and language therapy teams

Dysphagia is a commonly encountered problem affecting one in 17 people in their lifetime.1 It describes difficulties with eating, drinking, and swallowing. In those presenting acutely or to primary care, a detailed history guides the decision about urgency, need, and nature of onward referrals. This article highlights salient points in the history and examination when a patient presents with dysphagia, preliminary investigations, and how these inform onward referral and management.

Dysphagia can be caused by functional or structural abnormalities of the oral cavity, pharynx, oesophagus, or gastric cardia and may be acute or chronic in presentation, depending on the cause. New onset dysphagia requires investigation for oesophageal, and possibly head and neck cancer, but is also associated with a variety of benign diseases, some of which are highlighted in table 1.

View this table:
Table 1

Benign causes of dysphagia

Malnutrition and aspiration pneumonia can be sequelae of dysphagia resulting from benign or malignant causes. These patients usually require care from a multidisciplinary team. Speech and language therapists play a key role in assessing and managing swallowing disorders and should be involved early, alongside the dietetic team if there are concerns about nutritional intake.

How common is dysphagia?

Because dysphagia may manifest as a singular symptom or as one of a collection, the prevalence is uncertain. However, it is more common with ageing and is estimated …

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