Barium swallow of a patient with achalasia cardia classically shows which appearance at the gastro-oesophageal junction?
- A Shouldering with abrupt mucosal cut-off
- B Cobblestone mucosal pattern
- C 'Bird beak' or 'rat tail' tapering ✓
- D Concentric narrowing with intact mucosa and apple-core pattern
Correct answer: C. 'Bird beak' or 'rat tail' tapering
Explanation
Achalasia on barium swallow shows a dilated oesophagus (megaoesophagus) with smooth, symmetric, concentric tapering at the lower oesophageal sphincter producing the classic 'bird beak' or 'rat tail' appearance — the contrast column narrows to a point inferiorly. This reflects failure of LOS relaxation due to loss of inhibitory myenteric neurons. Shouldering with mucosal cut-off indicates carcinoma. Cobblestone mucosa is seen in Crohn's disease of the oesophagus/small bowel. Apple-core (annular) stricture is classic for carcinoma of the colon.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.