Which finding would most prompt urgent endoscopic evaluation in a patient with dysphagia?

• A. Mild, intermittent heartburn.
• B. Odynophagia with weight loss.
• C. Occasional cough after meals.
• D. No symptoms and normal diet.

Answer: (B)

Alarm features in dysphagia require urgent endoscopy. Odynophagia means painful swallowing, pointing to mucosal injury, ulceration, infection, or a lesion. When this is paired with weight loss, it raises concern for a serious, progressive process such as esophageal cancer or severe esophagitis. That combination justifies directly visualizing the esophagus with endoscopy and taking biopsies to identify the cause and guide immediate management.

Mild, intermittent heartburn is a common reflux symptom and not an immediate red flag. Occasional cough after meals can be reflux-related but without other alarming signs it doesn’t mandate urgent endoscopy. No symptoms with a normal diet shows no current concerns.