Progressive swallowing difficulties, more so to solids.
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Dilated, adynamic esophagus with a fluid level and failure to empty.
Bird beak appearance at the GEJ. Trace of barium into the stomach.
The appearances of achalasia are almost pathognomonic on barium swallow. These include:
1. A gas filled dilated esophagus on control film
2. A distended esophagus with an air-fluid level
3. An adynamic esophagus
4. A distal acute taper of the esophagus with a bird-beak appearance.
The bird-beak sign is used to refer to the tapering of the inferior esophagus in achalasia. This has a smooth outline implying a non-malignant cause. A rat's tail appearance is used interchangeably.