The main abnormality here is severe esophageal dysmotility. Other typical features shown here are the patulous esophagus, smooth tapering, patulous duodenum and delayed duodenal/gastric emptying. Severe reflux was also demonstrated (no images). The gastro-esophageal junction measured 1.5 cm. This is borderline normal, and balloon dilatation is usually considered with a cut-off of 1.3 cm. 

Companion radiographs of both hands in this patient show typical dystrophic soft tissue calcifications and arthropathy as described.