A brief and logical history is the most useful diagnostic tool when investigating patients with dysphagia because it provides a reliable indication of the underlying pathology and dictates the subsequent investigative algorithm.
- A brief structured history is the single most important step in evaluating patients with dysphagia because it identifies the likely pathophysiological process in 85% of cases.
- The history will generally reliably distinguish pharyngeal from oesophageal dysphagia and also a structural oesophageal disorder from dysmotility.
- A common mistake is to confuse the common, purely sensory symptom of globus with dysphagia. The swallow is completely normal in patients with globus.
- Endoscopy is almost invariably indicated in patients with dysphagia but, in some cases, a combination of endoscopy, radiography and oesophageal manometry is necessary to confirm a diagnosis.
- The finding of a normal endoscopy and normal barium swallow does not adequately rule out a structural or mucosal oesophageal cause for dysphagia.