Impact of referral delays on dysphagia outcomes in a Saudi tertiary center.

BACKGROUND: Dysphagia requires prompt evaluation but data regarding referral-to-assessment intervals and its association with outcomes in tertiary care are scarce, especially in Saudi Arabia. AIM: To investigate the assessment and outcome of consecutive dysphagia referrals to a tertiary gastroenterology practice. METHODS: This retrospective single-center study analyzed 207 consecutive dysphagia referrals to King Saud Medical City (2022-2023). Data collection included referral timelines, diagnostic investigations, etiologies and outcomes. Statistical Package for the Social Sciences version 28.0, employing χ 2 tests and analysis of variance, with P < 0.05 considered statistically significant. RESULTS: Total 168 patients included in this study (mean age 45.7 ± 17.7 years, 50% male), referral delays > 2 weeks occurred in 44% for clinical assessment and 50% for endoscopy. Gastroesophageal reflux disease was most common (45.2%), followed by eosinophilic esophagitis (14.8%) and malignancy (6.5%). Patients receiving endoscopy within 2 weeks showed an 84.6% improvement, compared to 76.0% with delayed referral (P = 0.012). All malignant cases were referred within 2 weeks, compared to 52.7% of non-malignant cases (P = 0.013). However, 67% of the malignant cases worsened, and 33% died. CONCLUSION: Early endoscopy within 2 weeks provides significant benefit. Optimised management of dysphagia should consist of more direct referral pathways.