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Achalasia Fluoroscopy Findings

Achalasia: Findings on Fluoroscopy with Barium Swallow Barium Swallow Patient swallows barium contrast (radiopaque), which outlines the gastrointestinal tract on fluoroscopy Authors: Nameerah Wajahat, Omer Mansoor, Aly Valji, Yahya Dawood Reviewers: Tara Shannon, Reshma Sirajee, Alua Kulenova Stephanie Nguyen* *MD at time of publication Achalasia Loss of distal esophageal peristalsis with impaired lower esophageal sphincter (LES) relaxation, causing obstructed passage of solids & liquids** Secondary disease processes can cause denervation or nerve dysfunction of esophageal myenteric plexus (EMP) Secondary (Pseudo) Achalasia Due to another disease process (e.g., tumor, Chagas disease, diabetes mellitus) Primary Achalasia (idiopathic) Inflammation & degeneration damage nerves in the esophageal wall Dysfunction of the esophageal myenteric plexus impairs peristalsis & sphincter relaxation Visual differences from primary achalasia Look for fixed abnormalities &/or mucosal irregularities & shouldering in the setting of a tumor Incomplete relaxation of the lower esophageal sphincter (LES) Loss of peristalsis in the distal esophagus Barium is delayed at the LES with hindered passage into the stomach Barium highlights the level of obstruction & upstream dilation Normal study possible despite disease: If suspicion remains, perform esophageal manometry (gold standard) or upper endoscopy **See corresponding Calgary Guide slide: Achalasia: Pathogenesis and Clinical Findings Esophageal Dilation Occurs upstream of narrow LES Bird Beak Sign / Rat Tail Sign Smooth, tapered narrowing of the distal esophagus Incomplete LES relaxation Image Source: Radiopaedia Legend: Pathophysiology Mechanism Radiographic Findings Complications Published Aug 30, 2026 on www.thecalgaryguide.com Creative Commons