PWE-128 Increasing rates and changing patterns of referral for patients with dysphagia to a single metropolitan hospital

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Dysphagia affects 3%–17% of the general population at least intermittently in Western countries. There is a well-documented increase in incidence and prevalence of eosinophilic oesophagitis over the past two decades. There are few data, however, on the aetiology of dysphagia over time among patients referred to gastroenterological clinics over the past decade.


Patients referred to a gastroenterology outpatient service at a single tertiary metropolitan hospital with dysphagia over 2011 to 2016 were identified, and case notes were retrospectively interrogated for clinical characteristics, investigations performed and final aetiology. Evolution of these features over time was noted.


418 patients (54.3% female, mean age 62.3 [range 15–96] y) with dysphagia were identified. A gradual increase in number of patients referred over the 6 year period (from 43 in 2011 to 124 in 2016) was found. Following evaluation, 174 (41.6%) patients were found to have a structural cause for dysphagia, 154 (45.7%) found to have dysmotility or a functional cause, and 60 (14.4%) mixed aetiology. Most patients (344, 82.3%) had oesophageal dysphagia, with oropharyngeal dysphagia present in 48 (11.5%) patients, and no definite cause found in the remainder. The primary cause for dysphagia was found to be gastro-oesophageal reflux disease (GORD) without oesophagitis in 24 (5.74%) patients, and with oesophagitis in 26 (6.22%) patients. Eosinophilic oesophagitis (EOE) was present in 50 (12%) patients overall. A stricture due to other causes was found in 64 (15.3%) of patients. Oesophageal cancer was only found in 5 (1.2%) of patients referred for investigation of dysphagia to the gastroenterology outpatient service, in whom adenocarcinoma was present in 3 and squamous cell carcinoma in 2 patients. Oesophageal dysmotility was present in 122 (29%) of patients, of whom 16 (3.8%) had features diagnostic of achalasia. Over the 6 year period, EOE numerically but not significantly rose as a proportion of patients with dysphagia (3 of 43 to 19 of 124, p=0.199, Fisher’s exact), oesophagitis and strictures remained stable (11 of 43 to 38 of 124, p=0.566), and dysmotility remained stable (11 of 43 to 31 of 124, p=1.0).


A gradual increase in number of patients with dysphagia were referred to the outpatient service of a metropolitan tertiary centre from 2011 to 2016. Eosinophilic oesophagitis as the primary cause for dysphagia numerically but not significantly increased, but other causes including oesophagitis, strictures and dysmotility remained stable. Malignancy was relatively infrequent among this cohort.

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