Incidence and predictive features of pharyngeal pouch in a dysphagic population

Pharyngeal pouch patients often present with dysphagia and risk perforation when undergoing gastroscopy. Knowledge of pharyngeal pouch incidence and predictive demographic features in patients referred for dysphagia would help determine those patients who should have barium swallow as an initial investigation. The prospectively collected data of 2,797 consecutive referrals were analysed. Logistic regression determined significant variables for predicting pharyngeal pouches. Of the 2,430 patients investigated [mean age = 67.7 years, range 17-103; 48.2 % male], 49 (2.0 %) had a pharyngeal pouch [mean age = 79.8 years (range 58-93); 53.1 % male]. Significant predictors of pharyngeal pouch were pharyngeal level dysphagia (odds ratio [OR] 3.8-19.2), age over 65 years (OR 2.2-14.1), symptom duration over 12 weeks (OR 1.1-3.9), and no weight loss (OR 1.1-5.5). Only 18 patients (36.7 %) underwent surgery for their pouch. Midsternal dysphagia alone occurred in 16 % of all patients with pouches. From our results we conclude that pharyngeal pouches in a dysphagic population are more common than previously recognised. Patients aged over 65 years with pharyngeal level dysphagia for more than 12 weeks should have a barium swallow as their initial investigation.