Feature Article

Difficult and painful swallowing: a guide for GPs

Shehan Abeygunasekera, Ian J Cook



An accurate history will generally establish the diagnoses of dysphagia and odynophagia. Differentiation of oropharyngeal from oesophageal dysphagia enables efficient investigation and appropriate treatment. Odynophagia can be distinguished from dysphagia but the conditions may coexist.

Key Points

  • An accurate provisional diagnosis of the cause of dysphagia can usually be made on the basis of a careful history.
  • It is important to differentiate between oropharyngeal and oesophageal dysphagia.
  • Malignant dysphagia usually presents with a short history of progressive dysphagia.
  • Intermittent dysphagia for both liquids and solids is characteristic of a motility disorder such as achalasia.
  • Endoscopy should generally be the first investigation in cases of suspected oesophageal dysphagia, unless dysmotility or an oesophageal ring is the likely underlying cause.
  • A modified barium swallow should be the initial investigation of suspected oropharyngeal dysphagia.