# Difficulty Swallowing (Dysphagia)

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: Dysphagia - StatPearls (NCBI Bookshelf NBK559174) - https://www.ncbi.nlm.nih.gov/books/NBK559174/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class DS21 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care
- Verified date: 2026-08

## Verified against

- No dose - referral pathway, no medicine given in primary care
- Difficulty Swallowing (Dysphagia) - disease-level clinical article (dysphagia-full.txt)

## Treatment metadata

- No drug therapy in primary care (Referral & Advice)

## Complete treatment card

```text
DIFFICULTY SWALLOWING (DYSPHAGIA)
Sources: Dysphagia - StatPearls (NCBI Bookshelf NBK559174) -
         https://www.ncbi.nlm.nih.gov/books/NBK559174/ · ICPC-3 (WONCA International Classification
         of Primary Care, 3rd edition) class DS21 - condition scope only, no dose · No dose -
         referral pathway, no medicine given in primary care
Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care,
               Difficulty Swallowing (Dysphagia) - disease-level clinical article
               (dysphagia-full.txt)  (2026-08)

IS IT THIS? - reference only, to read alongside your own examination
  SYMPTOMS - what the patient reports (5)
    - Solid-food dysphagia points toward a mechanical narrowing such as an esophageal web or ring
      [difficulty swallowing · stricture]
    - Steadily worsening dysphagia raises concern for a progressive stricture or malignancy
      [difficulty swallowing · stricture]
    - Liquid dysphagia points to a motility problem like achalasia or systemic sclerosis
      [difficulty swallowing]
    - Undigested-food regurgitation with hoarseness, bad breath, and throat fullness points to a
      Zenker diverticulum  [diverticulosis · hoarseness · regurgitation]
    - A smoking or alcohol history, with or without unintended weight loss, raises suspicion for
      malignancy
  SIGNS - what you find (1)
    - Exam may show poor dentition or gum disease, abnormal lip closure, mucosal change, or
      neurological signs
  TESTS (5)
    - A bedside clinical swallow evaluation is the initial test but can miss over half of
      significant aspiration
    - Videofluoroscopic swallow study visualizes bolus passage to assess swallow physiology and
      aspiration risk
    - FEES passes an endoscope through the nose to directly view the pharynx and larynx during
      swallowing
    - Barium esophagogram is a simple, low-cost first-line test for esophageal dysphagia
    - High-resolution manometry helps diagnose achalasia, diffuse esophageal spasm, and jackhammer
      esophagus
  IF NOT THIS - what else fits (12)
    - Benign esophageal stricture
    - Cerebrovascular accident (stroke)
    - Diffuse esophageal spasm
    - Eosinophilic esophagitis
    - Esophageal malignancy
    - Esophageal webs and rings
    - Gastroesophageal reflux disease (GERD)
    - Hiatal hernia is on the differential
    - Multiple sclerosis is on the differential
    - Parkinson disease is on the differential
    - Zenker diverticulum is on the differential
    - Dysphagia lusoria, a childhood form from vascular compression of the esophagus such as an
      aberrant right subclavian artery or double aortic arch
  Source  StatPearls "Dysphagia" - disease-level clinical article
  Status  traced to the source above

1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)    [1st line]
   Adult    Difficulty swallowing is a red-flag symptom, especially when progressive, and needs
            referral for endoscopy to exclude oesophageal or gastric cancer; a GP may trial acid
            suppression for suspected reflux while arranging that referral. - Refer, with advice
   Peds     Children follow the same pathway: recognise and refer. No primary-care medicine is
            implied.
   Source   No dose - referral pathway, no medicine given in primary care
   Why      Difficulty swallowing is a red-flag symptom, especially when progressive, and needs
            referral for endoscopy to exclude oesophageal or gastric cancer; a GP may trial acid
            suppression for suspected reflux while arranging that referral.
   Caution  No medicine is prescribed for this in primary care - this entry is for recognition and
            referral. Anything given is decided by the service it is referred to.
            RED FLAG - There is a risk of aspiration, aspiration-induced pneumonia, malnutrition,
            and dehydration as major complications of dysphagia.
            RED FLAG - Progressive dysphagia, especially solids progressing to liquids, dysphagia
            with weight loss or pain on swallowing, or coughing or choking with swallowing which
            carries an aspiration risk: refer urgently for endoscopy.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.
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