Long standing dysphagia for both solids and liquids.
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Smooth narrowing of the distal esophagus is seen with slow passage of contrast even in standing position, associated with moderate dilatation proximally and air fluid level compatible with achalasia.
No evidence of reflux or hernia.
No evidence of contrast aspiration.
Hypopharynx appears normal with normal swallowing mechanism.
This is 45 year old gentleman presenting with mainly dysphagia to both solids and liquids. The gastrointestinal team requested barium swallow and showed typical appearances of achalasia, and proceeded afterwards with upper endoscopy with findings that also supported primary achalasia.