Assessment and outcome of dysphagia referrals to a tertiary gastroenterology center in Saudi Arabia

Aims Our purpose was two-fold:

1- To audit how well we are meeting the Canadian consensus (within 2 months) and determine if there have been adverse outcomes related to delays.

2- To evaluate, based on outcomes versus presenting features, whether improvements to the referral process could help identify patients needing more rapid access. Thus, our goal was to assess the assessment and outcome of consecutive dysphagia referrals to a tertiary gastroenterology practice.

Methods We reviewed consecutive dysphagia referrals to the Gastroenterology department at King Saud Medical City over a 2-year period. We conducted chart reviews of all these referrals and gathered information on demographic data, related medications and diagnoses, presentation, time of referral, clinical assessment, imaging, and endoscopy. Inclusion criteria included all patients referred for dysphagia, aged 18 years and above. Exclusion criteria:Patients who did not attend their endoscopy appointment or refused upper endoscopy, Patients who lost follow-up without a final diagnosis and Patients under 18 years of age.

Results A total of 168 patients were included in the study. Their ages ranged between 18 and 87 years, with a mean±SD of 45.7±17.7 years. Most referrals came from the Family Medicine department (69.4%). The duration of dysphagia was four weeks or more in 44.5% of cases. The time from referral at the primary site to clinical assessment by the gastroenterology department within two weeks in 56% of patients, whereas the time from referral to endoscopy within two weeks in 50% of cases. The most frequently reported cause of dysphagia was Gastroesophageal Reflux Disease (GERD) (45.2%) followed by Esinophilic oesophagitis (14.5%). Most patients with dysphagia (61.3%) improved after management, while only 4.2% experienced worsening, and 1.8% died. Delays were associated with worse outcomes. All malignant cases were referred from the primary department of presentation to clinical assessment by the gastroenterology department and from clinical assessment to endoscopy within two weeks or less, compared to 52.7% and 47.3% of non-malignant cases [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11].

Conclusions This study highlights the critical importance of timely referral and assessment in the management of dysphagia, aligning with the Canadian consensus of completing assessments within two months. The data indicate that while more than half of the patients received assessments and essential procedures within this timeframe, delays were still associated with poorer outcomes, particularly in cases involving malignancy.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

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