Investigation of dysphagia

Dysphagia is an important and common symptom and the cause can be ‘functional’ or ‘structural’. ‘High dysphagia’ is most likely to be functional and related to neuromuscular disease. ‘Low dysphagia’ is more often structural in nature or due to oesophageal motility disorders.The history can often suggest the cause. Chronic symptoms are most likely due to motility disorders (e.g. achalasia). A short history of progressive dysphagia suggests oesophageal malignancy. Physical examination is often unrewarding, although a neurological disorder may be pertinent. High dysphagia with features of a neurological disorder is best investigated by videofluroscopy. Low dysphagia should be investigated initially by upper gastrointestinal endoscopy. A barium study should be the first line of investigation if a pharyngeal pouch is suspected. Motility disorders should be investigated by a barium swallow and oesophageal manometry. A 24-hour-study of pH is helpful if reflux is suspected as a causal factor in dysphagia. CT is a necessary complementary investigation if an oesophageal malignancy is suspected.