Referral to emergency
If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
- potentially life threatening of symptoms of:
- acute upper gastrointestinal (GI) tract bleeding
- oesophageal obstruction foreign body/food bolus
- dysphagia with inability to maintain oral hydration/nutrition
For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.
Central Adelaide Local Health Network
Northern Adelaide Local Health Network
- Lyell McEwin Hospital (08) 8182 9000
Southern Adelaide Local Health Network
Oropharyngeal dysphagia may be best assessed by neurology or speech pathology in the first instance.
Category 1 — appointment clinically indicated within 30 days
- new onset dysphagia especially if unresponsive to proton pump inhibitor (PPI) therapy
- progressive dysphagia for solids (especially in > 50 male obese smokers)
- dysphagia with significant recent weight loss ≥ 10% in previous 3 to 6 months
- dysphagia with recent food bolus obstruction
- referral for feeding tube insertion for progressive neurological disease
- dysphagia with abnormal imaging suggestive of malignancy (consider contacting gastroenterology registrar on call to discuss)
- dysphagia with symptoms suggestive of aspiration (consider contacting gastroenterology registrar on call to discuss, or referral to speech pathology)
Category 2 — appointment clinically indicated within 90 days
- all other dysphagia referrals
Category 3 — appointment clinically indicated within 365 days
For information on referral forms and how to import them, please view general referral information.
Essential referral information
Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.
- identifies as Aboriginal and/or Torres Strait Islander
- identify within your referral if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
- interpreter requirements
- description of swallowing symptoms including:
- type (solids/liquids/both)
- frequency (intermittent/progressive/every time/stable)
- pain whilst swallowing (odynophagia)?
- if yes, immunosuppression - inhaled steroids for asthma indicated.
- did the condition resolve with proton pump inhibitor (PPI) therapy? Consider referral if Ear, Nose and Throat (ENT) is indicated
- response to PPI therapy if not previously started
- past history of gastro-oesophageal reflux disease (GORD), Barrett’s and family history of gastrointestinal (GI) cancer
- weight loss associated with swallowing difficulty within the past 3 months
- recurrent aspiration pneumonia or symptoms of aspiration (choking/cough)
- neurological history including – cerebral vascular accident, transient ischaemic attack, risk factors
- atopy including eczema, hay fever, asthma (eosinophilic oesophagitis in younger people)
- smoking, body mass index (BMI) and alcohol intake
- presence or absence of palpable epigastric mass, lymph nodes
- nutritional assessment including hydration status if dysphagia severe
- complete blood examination (CBE)
- iron studies
- computed tomography (CT) chest/abdomen/pelvis if significant weight loss in older patient > 50 with new dysphagia (consider contacting gastroenterology registrar on call to discuss)
Additional information to assist triage categorisation
- relevant imaging reports
- barium swallow in progressive dysphagia (solids)
Clinical management advice
Please note that referrals can be managed by the following specialist services:
- ear, nose and throat
A careful structured history is vital to identify people with dysphagia requiring urgent attention and those who can be reassured or have care via the ambulatory care setting.
New dysphagia, especially for solids, over liquids and not fully responsive to proton pump inhibitor (PPI) therapy - warrants an urgent barium swallow and referral for endoscopy. The highest risk group for oesophageal cancer is older, obese male smokers.
However, the most common causes of dysphagia are:
- gastro-oesophageal reflux disease (GORD) in younger people which should fully resolve with <2 weeks PPI therapy.
- dysmotility in older people affecting both liquids and solids typically non-progressive and associated with other risk factors for vascular disease.
Where dysphagia is associated with other significant or progressive neurological diseases such as Parkinson’s disease, multiple sclerosis (MS), and motor neurone disease (MND), dysphagia management is best coordinated via the patient’s current neurologist assisted by a speech pathologist/dietitian.
Speech pathology assessment is warranted if concerns are around of oropharyngeal dysphagia alone.
The role of Gastroenterology in this setting is for insertion of feeding tubes to support nutrition and maintain airway safety after the patient and their primary care team have come to a consensus.
Category 3 referrals are accepted at the discretion of the triaging clinician. If you are concerned that your patient requires specialist review, but the referral is declined, you are encouraged to contact the triaging clinician to discuss your concerns.
If a patient has been fully investigated within last 2 years and symptoms remain unchanged, clinician discretion is needed to appropriately refer and triage. In general, there is little value in repeat specialist assessment and/or endoscopic procedures in this scenario.