Can patients determine the level of their dysphagia?

Table 1 Diagnoses in patients with discrete pathology investigated for dysphagia between 2004 and 2015

Diagnosis	n (%)
Oesophageal cancer	270 (37.2)
Peptic stricture	261 (36.0)
Cricopharyngeal hypertrophy/pharyngeal pouch	95 (13.1)
Schatzki ring	75 (10.3)
Achalasia	24 (3.3)
Pharyngeal pouch and oesophageal cancer	1 (0.1)

Table 2 Accuracy in perceiving correct level of dysphagia correlated to final diagnosis

Diagnosis	Perceived single level (n)	Perceived diffuse level (n)	Absolute match
Achalasia	23	1	34.8%
Oesophageal cancer	243	27	47.3%
Peptic stricture	235	26	38.7%
Pharyngeal pouch	88	7	84.1%
Schatzki ring	66	9	40.9%

One patient perceived the obstruction as pharyngeal and had both pharyngeal (pouch) and distal (cancer) obstruction. Their data is not included in this table.

Table 3 Effect of level of obstructing lesion on patient ability to accurately localise the cause of their dysphagia

Level of obstructing lesion	Total (n)	Perceived as pharyngeal	Perceived as mid sternal	Perceived as lower sternal	Correct level identified
Upper	115	94	18	3	81.7%
Middle	130	39	64	27	49.2%
Lower	410	66	186	158	38.5%
Total	655	199	268	188	48.2%

Six hundred and fifty-five patients with a single obstructing oesophageal lesion with the test derived level shown in column 1 and the patient perceived level in columns 3-5. When a patient perceived their dysphagia correctly this is shown in bold. Some patients perceived more than one level of dysphagia (diffuse) but their data is not shown here for clarity (n = 71). Pearson χ² test gave P < 0.001.

Table 4 Associated symptoms and their ability to improve patient localisation of dysphagia n (%)

Symptom	Number reporting symptom	Number with symptom correctly localising dysphagia	P value
Regurgitation/choking	416/647 (67.4)	195/416 (46.9)	0.478
Reflux	339/649 (52.2)	152/339 (44.8)	0.059
Odynophagia	158/651 (24.3)	72/158 (45.6)	0.415
Chest pain	162/649 (25.0)	71/162 (43.8)	0.180
Change in diet	315/651 (48.4)	151/315 (47.9)	0.883
Weight gain	47/635 (7.9)	20/47 (42.6)	0.422
Weight loss	244/611 (39.9)	116/244 (47.5)	0.816