Dysphagia Is an Urgent Alarm SymptomNew or progressive difficulty swallowing — especially solids — in an adult always requires urgent 2-week wait endoscopy referral to exclude oesophageal and gastric cancer.
Oropharyngeal vs Oesophageal Dysphagia
| Feature | Oropharyngeal | Oesophageal |
|---|---|---|
| Location of difficulty | Initiating swallow; choking on starting | Feel food 'sticking' in chest |
| Cough | Immediate on swallowing | Less immediate |
| Regurgitation | Nasal regurgitation; aspiration | After delay |
| Liquids vs solids | Liquids often worse first | Solids first (obstruction); both (motility) |
| Common causes | Stroke, MND, Parkinson's, myasthenia | Cancer, stricture, achalasia, GERD |
Causes and Investigations
| Cause | Features | Diagnosis |
|---|---|---|
| Oesophageal cancer | Progressive; weight loss; male, smoker, reflux history | Upper GI endoscopy + biopsy |
| Peptic stricture | History of GERD; older patient; improves with PPI | Endoscopy + dilatation |
| Achalasia | Both solids AND liquids; regurgitation; bird beak on barium | Barium swallow; oesophageal manometry |
| Oropharyngeal (neurological) | After stroke, PD, MND; aspiration pneumonia risk | Speech and language therapy (SALT) assessment |
| Pharyngeal pouch | Gurgling noise; regurgitation of undigested food; visible lump | Barium swallow |
Aspiration RiskOropharyngeal dysphagia carries significant risk of aspiration pneumonia. SALT (speech and language therapy) assessment is essential to guide dietary modification and feeding technique. Thickened fluids reduce aspiration risk.
Is dysphagia always cancer?
No. Most dysphagia is caused by benign conditions — GERD stricture, oesophageal spasm, or neurological causes. However, progressive dysphagia for solids always needs endoscopy to exclude cancer — don't delay.
What is achalasia?
A motility disorder where the lower oesophageal sphincter fails to relax, and the oesophageal body loses coordinated peristalsis. Causes dysphagia for both solids AND liquids (unlike cancer, which initially blocks solids only). Treated with pneumatic dilatation, Heller myotomy, or POEM (per-oral endoscopic myotomy).
What does an endoscopy for dysphagia involve?
A flexible camera passed through the mouth to examine the oesophagus, stomach, and duodenum. Takes 5–10 minutes. Sedation is offered. Any suspicious tissue is biopsied immediately.
What is a barium swallow?
An X-ray study where you swallow barium contrast — outlines the oesophagus and reveals structural or motility problems. Particularly useful for pharyngeal pouches, achalasia, and oropharyngeal dysphagia.
Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.