Version May 2024
| Do you have problems initiating a swallow or do you feel food getting stuck a few seconds after swallowing? (Helps distinguish oropharyngeal from esophageal dysphagia.) |
| Do you cough or choke or is food coming back through your nose after swallowing? (Coughing, choking, or nasal regurgitation suggests aspiration and oropharyngeal dysphagia.) |
| Do you have problem swallowing solids, liquids, or both? (Liquids, not solids, suggests a motility disorder; solids progressing to liquids suggests a benign or malignant obstruction.) |
| How long have you had problems swallowing and have your symptoms progressed, remained stable, or are they intermittent? (Rapidly progressive dysphagia is concerning for malignancy.) |
| Could you point to where you feel food is getting stuck? (Ability to localize source of dysphagia is unreliable; best with oropharyngeal dysphagia.) |
| Do you have other symptoms such as loss of appetite, weight loss, nausea, vomiting, regurgitation of food particles, heartburn, vomiting fresh or old blood, pain during swallowing, or chest pain? |
| Do you have medical problems such as diabetes mellitus, scleroderma, Sjögren's syndrome, overlap syndrome, AIDS, neuromuscular disorders (stroke, Parkinson's, myasthenia gravis, muscular dystrophy, multiple sclerosis), cancer, Chagas' disease or others? |
| Have you had surgery on your larynx, esophagus, stomach, or spine? |
| Have you received radiation therapy in the past? |
| What medications are you using now (ask specifically about potassium chloride, alendronate, ferrous sulfate, quinidine, ascorbic acid, tetracycline, aspirin and NSAIDs)? (Pill esophagitis can cause dysphagia.) |
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