What initial assessments should I perform for a patient presenting with dysphagia to determine the underlying cause?

Initial assessments for a patient presenting with dysphagia should include:

• Clinical history: Take a detailed history focusing on symptoms such as difficulty or pain on swallowing, coughing or choking during or after eating, regurgitation, drooling, hoarse voice, sensation of obstruction, and any history of recurrent chest infections or weight loss.
• Observation of eating and drinking: Observe the patient during a normal meal to assess the safety, efficiency, and enjoyment of eating and drinking, ideally performed by a healthcare professional trained in dysphagia assessment, such as a speech and language therapist.
• Screen for associated signs: Look for less obvious indicators such as changes in respiration pattern, wet voice quality, frequent throat clearing, and recurrent chest infections.
• Physical examination: Conduct a general and focused examination including respiratory and cardiovascular systems to identify any underlying causes or complications.
• Medication review: Review current medications to assess if any drugs may affect swallowing or feeding regimens.
• Referral: Refer to a specialist multidisciplinary team with expertise in dysphagia assessment if there are clinical concerns such as coughing, choking, recurrent chest infections, or distress during meals.

Videofluoroscopy or fibroscopic endoscopy should not be used as initial assessments but reserved for specialist evaluation if uncertainty remains after clinical assessment or if there are recurrent chest infections without overt aspiration signs.

Regular monitoring and reassessment are important until the patient is stable.

These steps help determine the underlying cause of dysphagia and guide further management.

References: NICE NG62,NICE CG32,NICE NG236