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