When should I consider referring a patient with dysphagia for a specialist evaluation or further investigations?

Consider referring a patient with dysphagia for specialist evaluation or further investigations if they present with any obvious or less obvious indicators of dysphagia such as difficulty or pain swallowing, regurgitation of undigested food, coughing or choking during swallowing, hoarse voice, unintentional weight loss, or recurrent chest infections. These signs suggest the need for assessment by healthcare professionals with relevant skills in swallowing disorders to diagnose and manage the condition appropriately.

Referral is particularly important in patients with acute or chronic neurological conditions or those who have had surgery or radiotherapy to the upper aero-digestive tract, as they are at high risk of developing dysphagia.

Additional factors to consider before referral include recurrent chest infections, dependency on others for eating, poor oral hygiene, compromised medical status, and nutritional requirements. A drug review should also be performed to ensure medications do not interfere with swallowing or feeding regimens.

Regular monitoring and reassessment by specialists are recommended for patients receiving modified food and liquid diets until their condition stabilizes.