Abstract

Dysphagia (subjective difficulty in swallowing) is a common clinical problem, particularly in the elderly population. Ideally, patients should be assessed promptly in the appropriate outpatient setting, but frequently they will be admitted on an acute medical take due to ‘total’ dysphagia, dehydration, debilitation or possible aspiration. A careful history and examination can usually elucidate the site of the lesion and its possible cause, and thus direct initial management. This article will concentrate on the role of the acute physician in the assessment of patients with dysphagia within the first 48 hours of presentation.
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References

1. Lindgren S, Janzon L; Prevalence of swallowing complaints and clinical findings among 50-79 year old men and women in an urban population. Dyspahgia 1998; 6: 187-192.
2. Tibbling L, Gustafsson B; Dysphagia and its consequences in the elderly. Dysphagia 1991; 6: 200-202.
3. Layne KA, Losinski DS, Zenner PM et al; Using the Fleming index of dysphagia to establish prevalence. Dysphagia 1989; 4: 39-42.
4. Perry L, Love CP; Screening for dysphagia in acute stroke. Dysphagia 2001; 16: 7-18.
5. Spieker MR; Evaluating dysphagia. Am Fam Physician 2000; 61: 3639- 48.
6. Travis SPL, Taylor MR, Misiewicz JJ: Pocket Consultant: Gastroenterology, ed.2, 1998, Oxford University Press.
7. Barr H: Oesophageal cancer. Medicine 1998; 26(7): 7-10.
8. Leslie P, Carding PN, Wilson J; Investigation and management of chronic dysphagia. BMJ 2003; 326: 433-436.
9. Webb W; Managemant of foreign bodies of the upper gastrointestinal tract: update. Gastrointest Endosc 1995; 41(1): 39-51.
10. Blot WJ, Devesa SS, Kneller RW et al; Increasing incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 1991; 265: 1287-1289.
11. Pera M, Cameron AJ, Traskek VF et al; Increasing incidence of adenocarcinoma of the esophagus and esophagogastric junction. Gastroenterology 1993; 104: 510-513.
12. Lerut T, Coosemans W, Raemdonck DV, Dillemas B et al; Surgical treatment of Barrett’s carcinoma: Correlation between morphologic findings and prognosis. J Thorac Cardiovasc Surg 1994; 107: 1059-1065.
13. Grannell MS, Kelly S, Shannon S et al; The sinister significance of dysphagia. Ir J Med Sci 2001; 170(4): 244-245.
14. Hamilton SR, Smith RRL, Cameron JL; Prevalence and characteristics of Barretts oesophagus in patients with adenocarcinoma of the esophagus and esophagogastric junction. Hum Pathol 1988; 19: 942-948.
15. van der Burgh A, Dees J, Hop WCJ et al; Oesophageal cancer is an uncommon cause of death in patients with Barrett’s oesophagus. Gut 1996; 39: 5-8.
16. MacDonald CE, Wicks AC, Playford RJ; Final results from 10 year cohort of patients undergoing surveillance for Barrett’s oesophagus: observational study. BMJ 2000; 321: 1252-1255.
17. Wright TA, Gray MR, Morris AI et al; Cost effectiveness of detecting Barrett’s cancer. Gut 1996; 39: 574-579.
18. Fitzgerald RC, Saeed IT, Khoo D et al; Rigorous surveillance protocol increases detection of curable cancers associated with Barrett’s oesophagus. Dig Dis and Sci 2001; 46(9): 1892-1898.