Dr Paul Kuo( left) Consultant gastroenterologist, Royal Adelaide Hospital, SA.

Dr Sophie Burn( centre) Gastroenterology registrar, Royal Adelaide Hospital, SA.

Dr Bianca Angelica( right) Consultant gastroenterologist, Royal Adelaide Hospital, SA.

Copyright © 2025 Australian Doctor All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means without the prior written permission of the publisher. For permission requests, email: howtotreat @ adg. com. au.

This information was correct at the time of publication: 22 August 2025

INTRODUCTION

DYSPHAGIA is frequently encountered

in primary care, resulting in significant demands on healthcare resources. Apart from troublesome symptoms, complications— including aspiration, weight loss and malnutrition— may arise. 1, 2 It is also important to recognise the potential negative impact on a person’ s psychosocial wellbeing from avoidance of meal-related activities.

It is crucial to take a detailed history as part of the initial evaluation to determine the likely aetiology, as well as to guide appropriate investigations and referrals. Specialties to which referrals are made include gastroenterology, ENT surgery, neurology and speech pathology.

Management is guided by the underlying aetiology, with the goal of treating pathology and maximising the patient’ s quality of life by reducing their symptom burden.

This How to Treat provides a recommended approach to patients with dysphagia in the general practice setting. It aims to ensure GPs can achieve proficient knowledge on the topic and appropriately diagnose and refer patients with efficiency and confidence.

EPIDEMIOLOGY

DYSPHAGIA is increasingly common in the general population. 3 It is more common in the elderly— in part because of underlying comorbid conditions, including cerebrovascular disease; neurodegenerative conditions, such as Parkinson’ s disease and dementia; and a greater prevalence of oesophageal dysmotility. 4

Up to 60 % of nursing home residents experience dysphagia. 5 However, some aetiologies are more common in the younger population, such as eosinophilic oesophagitis, which has seen a rise in incidence over the past two decades, partly as a result of greater recognition of the condition. 6, 7 Gastro-oesophageal reflux disease( GORD) can also be a cause for dysphagia without an associated structural abnormality. 8

The use of opioids has recently been recognised as an important cause of oesophageal dysmotility and dysphagia, which has particular relevance given the frequent prescription of these medications. 9, 10 Most epidemiological studies predominantly assess dysphagia in the older population: these have

Table 1. Risk factors

Condition

GORD

Smoking

Atopy

Immunocompromise

Cerebrovascular disease, neurodegenerative disorders( eg, Parkinson’ s disease, dementia)

Head and neck surgery +/- irradiation

Thyroid disease

Connective tissue disorders( eg, systemic sclerosis)

demonstrated a prevalence between 16 % and 22 %. 11 A self-validated survey of a random sample of 1000 individuals in Sydney, Australia found that 16 % of respondents reported ever having dysphagia; this was associated with an overall reduced quality-of-life score, with incidence comparable between males and females. 11

Potential implication

Oesophageal hypomotility, peptic stricture, adenocarcinoma

Oesophageal SCC

Eosinophilic oesophagitis

Candida, CMV oesophagitis

Oropharyngeal dysphagia

Scarring and strictures of upper aerodigestive tract

Extrinsic compression from goitre

Oesophageal hypomotility

A number of risk factors have been identified( see table 1) and primarily relate to the underlying aetiology. 4, 11

PATHOPHYSIOLOGY

NORMAL swallowing starts with elevation of the tongue and co-ordinated contraction of the pharyngeal muscles that push a bolus into the hypopharynx. This results in