Dysphagia

Background

Dysphagia is defined as difficulty swallowing. 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.

NHS Scotland dysphagia pathway

Click on the image below to open the pathway

Pathway recommendations

Guidance for primary care

Dysphagia is defined by the cancer referral guidelines as ‘persistent or progressive dysphagia, not ‘feeling of something stuck in the throat’ (FOSSIT).

There are both neurology and Ear, Nose and Throat (ENT) causes for dysphagia. Patients should be referred to the appropriate specialty, e.g.

choking or hoarse voice symptoms should be referred to ENT
neurologic disease or symptoms should be referred to Neurology

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) (see EDS section below). Those with a low EDS should be referred for investigation to exclude other non malignant causes such as Eosiniophillic Oeosphaitis.

It is vital to include relevant information in the referral to secondary care to allow the EDS to be calculated.

This should include:

weight loss above 3 kilograms (kg)
current reflux
duration of symptoms, and
whether symptoms localise to the neck

Patients with a low EDS will be offered a routine investigation and advice about treatment for reflux while waiting for tests. Reflux disease is the most common cause of reflux in this group.

Edinburgh Dysphagia Score (EDS)

A
Age	Points
18-39	0
40-49	4
50-59	5
60-69	6
70-79	7
80-89	8
90-99	9

B
Gender	Points
Male	0
Female	-1

C
Current acid reflux	Points
Yes	-1
No	0

D
Dysphagia localises to neck	Points
Yes	-2
No	0

E
Weight loss more than 3kg	Points
Yes	2
No	0

F
Duration of symptoms more than 6 months	Points
Yes	-1.5
No	0

Edinburgh Dysphagia Score = A+B+C+D+E+F

If more than 3.5 the patient requires further investigation as higher risk of cancer
If less than 3.5 then lower risk

References and further resources

Patient resources

Patient information leaflet (provided by your NHS Health Board)

NHS inform illnesses and conditions: Dysphagia (swallowing problems)

References

NICE guideline CG184: Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and
management 2019 [Accessed 03/09/2025]

Beaton DR, Sharp L, Lu L, et al. Diagnostic yield from symptomatic gastroscopy in the UK: British Society of Gastroenterology analysis using data from the National Endoscopy Database. Gut. 2024 Aug 8;73(9):1421-1430. DOI: 10.1136/gutjnl-2024-332071

gjnh.cfsdpmo@gjnh.scot.nhs.uk