A 34-year-old male with hypertension and tobacco use presented to the gastroenter­ology clinic for 4years of dysphagia that had progressively worsened over the last 2years. He described difculty swallowing initially with solids which then pro­gressed to both liquids and solids, as well as regurgitation that interfered with his sleep. He denied abdominal pain, nausea, vomiting, and weight loss. He underwent an esophagogastroduodenoscopy (EGD), which showed a dilated esophagus with resistance in traversing the lower esophageal sphincter (LES) (Fig.1). Esophageal biopsies were negative for eosinophilic esophagitis. Unfortunately, the patient could not tolerate the placement of a manometry catheter, so high-resolution esophageal manometry was not performed. A timed barium esophagram was obtained demon­strating a dilated aperistaltic esophagus with bird beak appearance and retained con­trast in the distal esophagus, 20% of which emptied between 0 and 5min (Fig.2). He was then referred for an upper endoscopy with functional lumen imaging probe (FLIP). EndoFLIP revealed a low EGJ diameter, low distensibility index, and absence of esophageal contractions, consistent with achalasia (Fig.3). He ultimately underwent a peroral endoscopic myotomy (POEM) procedure with improvement in his symptoms.