Investigation of dysphagia

Dysphagia is a significant red flag symptom that always warrants urgent investigation. Although the majority of causes are benign, an underlying malignancy needs to be excluded. The mainstay of investigation of dysphagia involves flexible endoscopy. Direct visualization should not be delayed by other imaging, although caution should be adopted in view of the small but significant risks of the procedure. Further imaging can then be used to further clarify or stage an identified tumour. If a malignancy has been excluded, other investigations can be used to identify causes such as benign strictures or motility disorders.