What does the 'bird beak' sign on a barium swallow indicate?

• A. Achalasia
• B. Peptic stricture
• C. GERD
• D. Esophageal varices

Answer: (A)

The bird beak sign on a barium swallow points to a motility problem at the distal esophagus, specifically where the lower esophageal sphincter fails to relax and peristalsis is absent. This creates dilation above a sharp, tapered narrowing at the gastroesophageal junction—the classic appearance of Achalasia.

Peptic stricture can narrow the esophagus from scarring due to reflux, but it usually presents as a more gradual, scarred narrowing rather than the abrupt, pointed taper seen with Achalasia. GERD itself is a reflux condition and may lead to strictures over time, but it does not produce this distinctive bird beak shape. Esophageal varices involve dilated veins and appear as vascular, serpentine structures rather than a tapered segment.