Investigation and management of high dysphagia
| Investigations | Potential results | Clinical management plan |
|---|---|---|
| Actions from history, medication and dietary assessment | ||
| History findings | Dysphagia present | Refer for dietetic support. Refer for SLT assessment. |
| Neurological findings | Refer to neurology. | |
| Medication findings |
| Discuss possible alternative medications. |
| First line | ||
| Contrast swallow/fluoroscopy | Fistula with aspiration | This is an emergency. Discuss with thoracic surgery |
| Stricture, if <6 months after upper GI surgery | OGD±dilatation (p. 25). Consider treatment for acid/bile reflux (p. 25). | |
| Stricture, if after radiotherapy or >6 months after upper GI surgery | OGD with careful biopsy and consider treatment for acid/bile reflux (p. 25). CT±PET scan. Then review in MDT before any further treatment/stent/dilatation (p. 25). | |
| Malignancy/tumour recurrence | Refer to appropriate MDT requesting an appointment within 2 weeks. | |
| Inflammation (acid/bile) | See management of acid or bile related inflammation (p. 25). | |
| Pharyngeal dysfunction | SLT assessment. | |
| Local infection (viral/fungal) | Treat infection appropriately. | |
| Second line | ||
| OGD under GA (no endoscopic intervention until discussed at the MDT) | Inflammation (acid/bile) | See management of acid or bile related inflammation (p. 25). |
| Malignancy/tumour recurrence | Refer to appropriate MDT requesting an appointment within 2 weeks. | |
| Vocal cord palsy | CT scan and refer to cancer MDT within 2 weeks. Referral to SLT. | |
| CT chest | Malignancy/tumour recurrence | Refer to appropriate MDT requesting an appointment within 2 weeks. |
| Third line | ||
| Referral to ENT | Head and neck pathology | ENT team management. |
| Fourth line | ||
| If normal investigations/no response to intervention | Reassure. | |
CT, computerised tomography; ENT, ear, nose and throat; GI, gastrointestinal; MDT, multidisciplinary team; NSAID, non-steroidal anti-inflammatory drug; OGD, upper GI endoscopy (oesophago-gastroduodenoscopy); PET, positron emission tomography; SLT, speech and language therapy.