Achalasia - with bird beak sign

Case contributed by Andrew Ho


Longstanding sensation of food "stuck in her chest" and halitosis.

Patient Data

Age: 35 years
Gender: Female

Rapid sequence fluoroscopic images from a barium esophagogram reveal a persistently dilated esophagus with an air-fluid level at the lower esophagus and classic "bird-beaking" at the gastroesophageal (GE) junction, despite normal primary peristaltic waves.

Case Discussion

Achalasia can be divided into primary and secondary (pseudoachalasia):

  • primary achalasia is a smooth muscle motility disorder of the esophagus
  • secondary achalasia is abnormal stricturing of the gastroesophageal junction, such as tumor compression or Chagas disease

Esophagogram is important in the evaluation of motility, reflux, and aspiration.

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