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EBP Compendium: Summary of Clinical Practice Guideline

American College of Radiology (ACR)
ACR Appropriateness Criteria: Dysphagia

Jones, B., Gayler, B. W., et al. (2010).
American College of Radiology, 6 pages.

AGREE Rating: Recommended with Provisos


This guideline provides recommendations for the radiologic evaluation of individuals with dysphagia. The primary audience is radiologists, however the information is relevant to speech-language pathologists. Recommendations are separated into four categories:

  1. Oropharyngeal dysphagia with an attributable cause
  2. Unexplained oropharyngeal dysphagia
  3. Substernal dysphagia in immunocompetent patients
  4. Substernal dysphagia in immunocompromised patients.


  • Swallowing Screening/Assessment
    • If there is an attributable cause for the dysphagia, a modified barium swallow study is recommended. High-density or low-density barium suspensions may be used and substances of varying consistency (e.g. barium paste or barium-impregnated crackers) may be used. With the assistance of a speech therapist, compensatory maneuvers may be attempted.
    • If oropharyngeal dysphagia is unexplained, a more detailed barium study may be performed. A combination of videofluoroscopy and static images of the pharynx and esophagus can improve diagnostic value.
    • When evaluating substernal dysphagia in immunocompetent patients, the biphasic esophagram is the assessment of choice. Double contrast views are best for detecting mucosal lesions, whereas single-contrast views are best for detecting lower esophageal rings or strictures
    • The biphasic esophagram is also useful in assessing individuals with esophageal motility disorders.
    • Endoscopy may be performed to evaluate the esophagus for structural abnormalities.
    • In patients with immunocompromised substernal dysphagia, endoscopy is the assessment of choice. Barium esophagography may also be useful.

Keywords: Swallowing Disorders; Instrumental Assessment

Access the Guideline

Added to Compendium: October 2011

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