{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T20:05:06Z","timestamp":1777493106093,"version":"3.51.4"},"reference-count":31,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,5,14]],"date-time":"2018-05-14T00:00:00Z","timestamp":1526256000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Otolaryngology"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Dysphagia is a presenting symptom of both pharyngeal and oesophageal cancers. The referral pathway choice is determined by whether it is thought to be oropharyngeal or oesophageal, and this is in turn influenced by whether dysphagia is perceived to be above or below the suprasternal notch. We studied the concordance between the presence of pharynx\u2010localised dysphagia (<jats:styled-content style=\"fixed-case\">PLD<\/jats:styled-content>) and the location of the underlying disease processes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A subset analysis of the Dysphagia Hotline Cohort, collected between 2004 and 2015, of patients with <jats:styled-content style=\"fixed-case\">PLD<\/jats:styled-content> and a structural diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Information about patient demography and presenting symptoms were recorded. The incisor\u2010to\u2010pathology distance, and the nature of the pathology, were recorded. Logistic regression analysis was used to identify independent predictors of malignancy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study included 177 patients. There were 92 males, and mean age at presentation was 74 years. The commonest benign pathologies were cricopharyngeal dysfunction with or without pharyngeal pouch (n = 67), peptic stricture (n = 44) and Schatzki's ring (n = 11). There were 49 cases of cancer, including one hypopharyngeal cancer, one cervical oesophageal cancer, 28 cancers of the upper\/mid\u2010thoracic oesophagus, 15 cancers of the lower thoracic oesophagus and 4 cardio\u2010oesophageal cancers. In 105 (59%) patients, <jats:styled-content style=\"fixed-case\">PLD<\/jats:styled-content> was caused by oesophageal disease. Independent predictors of malignancy were weight\u2010change (loss &gt;2.7 kg), a short history (&lt;12 weeks) and presence of odynophagia. Nineteen (39%) of oesophageal cancers that presented with dysphagia that was localised only to the pharynx would have been beyond the reach of rigid oesophagoscopy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Pharynx\u2010localised dysphagia is more likely to be a referred symptom of structural oesophageal disease, including cancer, than a primary symptom of structural pharyngeal disease. Absence of additional alarm symptoms such as a short history, weight\u2010loss, and odynophagia, do not adequately exclude the possibility of oesophageal cancer. When the differential diagnosis of <jats:styled-content style=\"fixed-case\">PLD<\/jats:styled-content> includes malignancy, cancer should be presumed to be arising from the oesophagus or the cardio\u2010oesophageal region until proven otherwise. This requires direct visualisation of the mucosal surfaces of the oesophagus and the cardio\u2010oesophageal region, using either transoral or transnasal flexible endoscopy, irrespective of whether the initial assessment occurs within head and neck or upper gastrointestinal suspected cancer pathways.<\/jats:p><\/jats:sec>","DOI":"10.1111\/coa.13115","type":"journal-article","created":{"date-parts":[[2018,4,10]],"date-time":"2018-04-10T23:37:46Z","timestamp":1523403466000},"page":"1088-1096","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Oesophageal causes of dysphagia localised only to the pharynx: Implications for the suspected head and neck cancer pathway"],"prefix":"10.1111","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5604-1739","authenticated-orcid":false,"given":"S.A.R.","family":"Nouraei","sequence":"first","affiliation":[{"name":"Department of Ear Nose and Throat Surgery Poole Hospital 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