Dysphagia/odynophagia (Gastroenterology)

ADULT

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Oesophageal foreign body / food bolus obstruction
    • At risk of dehydration and acute malnutrition
    • Supraglottitis
    • Refer to HealthPathways for assessment and management recommendations.
    • Speech pathology assessment is warranted if concerned about oropharyngeal dysphagic symptoms only

    Note: If a patient who has been fully investigated 2 years prior to referral.  Then the referrer and the receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy / colonoscopy procedures.

Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)

Referrals for dysphagia should be directed through the most clinically appropriate pathway, which may include a Speech Pathology–led complementary care pathway, Ear, Nose and Throat (ENT) services, or Gastroenterology. The triage process should be guided by the patient’s predominant clinical features, the suspected underlying cause, and the investigations or interventions most likely to be required.

In some Hospital and Health Services (HHSs), patients may be considered for a Speech Pathology primary contact assessment either before or instead of being referred to ENT. This approach facilitates appropriate and timely referrals to:

  • ENT where oropharyngeal dysphagia or structural/neurogenic pathology is suspected or confirmed, and
  • Gastroenterology where oesophageal dysphagia (e.g. sensation of food sticking in the chest) or need for endoscopic evaluation is suspected

ENT referral pathway

  • Suspicion of oropharyngeal lesion, bleeding or ulceration – dysphagia and any of the following:
    • Persistent hoarseness (> 4 weeks)
    • Unilateral referred otalgia
    • Progressive weight loss, loss of appetite/food avoidance
    • Smoking history
    • Excessive alcohol intake
  • Significant or rapidly progressive oropharyngeal dysphagia or stenotic symptoms, and any of the following:
    • Gagging, choking, and/or coughing when swallowing
    • Oropharyngeal pain or referred pain to ear when swallowing
    • Shortness of breath post eating (in absence of other cause)
  • Recurrent chest infections (aspiration pneumonia)

Gastroenterology referral pathway

  • Significant oesophageal dysphagia with concerning features (≥5% unintentional weight loss over 6 months, smoking or excessive alcohol intake, reflux oesophagitis or Barrett’s oesophagus, or prior food bolus impaction), raising concern for:
    • Oesophageal cancer
    • Oesophageal stricture
    • Achalasia
    • Eosinophilic oesophagitis
    • Severe reflux-related narrowing
  • Suspected GI  malignancy on clinical examination or abnormal imaging
Category 2
(appointment within 90 calendar days)
  • Chronic oesophageal dysphagia (≥12 months or unclear duration) that is non-progressive, without concerning features (≥5% unintentional weight loss over 6 months, smoking or excessive alcohol intake, reflux oesophagitis or Barrett’s oesophagus, or recent [within 6 months] or recurrent food bolus impaction)
  • Chronic oesophageal dysphagia due to known benign conditions (e.g. achalasia, eosinophilic oesophagitis, benign oesophageal stricture), with adequate oral intake and without concerning features (as defined above)
    • Achalasia
    • Eosinophilic oesophagitis
  • Globus, in the absence of concerning features
Category 3
(appointment within 365 calendar days)

  • No category 3 criteria

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • History of presenting complaint:
    • Difficulty or pain on swallowing
    • ­Food or liquids are stuck in throat or chest
    • ­Pain or pressure in chest associated with swallowing
    • ­Loss of appetite/food avoidance associated with swallowing difficulty
    • ­Smoking history /alcohol intake
    • ­Thyroid disease
  • Neurology history (stroke, progressive neurological disease e.g. Parkinson’s disease)
  • Previous history head/neck oncological treatment
  • Presence of concerning features
  • Weight loss, ≥5% of body weight in previous 6 months
  • Recurrent nausea and/or vomiting
  • FBC iron studies results

3. Additional referral information Useful for processing the referral

  • Relevant imaging reports (e.g. cross-sectional imaging)
  • Videofluoroscopic swallow study (Barium swallow or modified barium swallow)
  • CT neck and chest (with contrast)
  • CXR
  • TSH

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • 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.

Last updated: 29 September 2026

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