Bird's peak sign is classically seen in the barium swallow of a patient suffering from achalasia. It arises because of the failure of the distal esophageal sphincter to relax along with impaired peristalsis of the esophagus. In this condition, the patient presents with dysphagia, often non progressive and regurgitation of undigested food. Malnutrition and weight loss are natural consequences. Treatment options range from medicines to relax the sphincter tone, Botox injections and myotomy to divide the muscular fibers of the sphincter. https://onlinelibrary.wiley.com/doi/full/10.1111/1754-9485.06_12784