In this section : Gastrointestinal
Dysphagia
Coeliac diagnosis pathway (Adults)
Sengstaken/Minnesota Tube for Bleeding Varices
Eradication of Helicobacter pylori
Acute Severe Ulcerative Colitis
Acute Upper GI Bleeding (AUGIB)
Iron Deficiency Anaemia
Dyspepsia
Nutritional Support in Adults
Refeeding Syndrome
Parenteral Nutrition
Crohn’s Disease
Acute Pancreatitis
Suspected Variceal Bleeding
Lower Gastrointestinal Bleeding
Home | Articles | Gastrointestinal |
Dysphagia
Last updated 14th January 2025
- Dysphagia is defined as persistent or progressive difficulty swallowing, not ‘feeling of something stuck in the throat’ (FOSSIT). It is a condition that can occur at any age but is more common in older adults. Dysphagia can be painful and, in some cases, swallowing may be impossible.
- Traditionally, true dysphagia has been a red flag symptom requiring urgent investigation. Patients who are likely to have cancer and need investigation can be identified by using the Edinburgh Dysphagia Score (EDS). Those with a low EDS should be referred for investigation to exclude other non-malignant causes such as Eosinophilic Oesophagitis. See below for more details.
- Bear in mind there are also neurology and ENT causes for dysphagia. Patients should be referred to ENT if choking or hoarse voice symptoms, or to neurology if dysphagia associated with dysarthria.
- Click this link to the NHS Scotland Centre for Sustainable Delivery Dysphagia Pathway
Edinburgh Dysphagia Score
- The Edinburgh Dysphagia Score (EDS) was developed with the aim of creating a simple yet highly sensitive scoring system that would allow patients to be categorised into low and high risk groups for an underlying nmalignant diagnosis based on key information present at referral. In the original study the EDS had a negative predictive value of 99.3% and a sensitivity of 97.5%
- The usefulness thereforeof EDS rests with the high negative predictive value; in the published study, only one patient with EDS <3.5 had malignancy as the cause of their dysphagia
- It was estimated that approximately 30-35% of dysphagia referrals from primary care had a score of <3.5 and would not require endoscopy through the urgent suspicion of cancer (USOC) / 2 week wait (2WW) pathway, although a lower priority endoscopy would still be required.
- An EDS ≥3.5 identified the group of patients at high risk for cancer and in that group the cancer yield at endoscopy was approximately 17-20%
- The Edinburgh Dysphagia Score can therefore be used to identify patients at lower risk of a malignant diagnosis and allow resources to be concentrated on those at highest risk
Scoring
A - Age | Points | D - Dysphagia localises to neck | Points | |
18-39 | 0 | Yes | -2 | |
40-49 | 4 | No | 0 | |
50-59 | 5 | E - Weight Loss >3kg | Points | |
60-69 | 6 | Yes | 2 | |
70-79 | 7 | No | 0 | |
80-89 | 8 | F - Duration of Symptoms >6m | Points | |
90-99 | 9 | Yes | -1.5 | |
B - Gender | Points | No | 0 | |
Male | 0 | |||
Female | -1 | |||
C- Current Acid Reflux | Points | |||
Yes | -1 | |||
No | 1 |
A+B+C+D+E+F=Edinburgh Dysphagia Score
If ≥3.5 then patient requires further investigation as higher risk of cancer
If <3.5 then lower risk
Content by Zahra Bayaty