Poor esophageal peristalsis, dilatation and barium retention in the pyriform fossa are digestive symptoms of dermatomyositis and polymyositis, which are currently considered to fall under the category of autoimmune diseases. Differential diagnosis of poor peristaltic dilatation and barium retention in the pear-shaped fossa should be made with which conditions: esophageal varices: abnormal function of the portal venous system, one of the main sources of blood supply to the liver, due to high pressure in it. The venous blood that is supposed to flow into this system and return to the heart is unable to do so and pools in the lumen, causing the veins to dilate abnormally and not retract to normal, also known as varices. The sources of blood flowing into the portal system include esophageal veins, umbilical veins, and hemorrhoidal veins, and the expansion of these vessels results in the formation of varicose veins in the corresponding areas, namely esophageal varices, dilated veins near the belly button, and hemorrhoids. Footprint of the left wall of the esophagus: Barium meal examination of the esophagus in congenitally narrowed aorta often shows a footprint of the enlarged thoracic descending aorta or enlarged right intercostal artery in the left wall of the esophagus, called the “E” sign, in the area of the narrowed aorta. Partial peristaltic arrest of the esophageal body smooth muscle and decreased tone of the lower esophageal sphincter: typical in patients with scleroderma esophagus. Scleroderma esophagus refers to scleroderma, which involves the esophageal muscle layer and develops its kinetic abnormalities. Esophageal involvement presents with dysphagia, heartburn, mostly accompanied by vomiting and a feeling of fullness behind the sternum or in the upper abdomen. Decreased peristaltic function of the esophagus: Esophagitis can cause decreased peristaltic function of the esophagus. The clinical manifestation is pain behind the sternum when swallowing. It can also cause esophageal spasm and transient dysphagia. Esophageal dilatation: There are two types: primary and secondary. Dilatation that occurs above the esophageal stricture is secondary dilatation, and primary dilatation is divided into two types: widespread dilatation and restrictive dilatation. Extensive dilatation, also known as congenital dilatation, has an unknown pathogenesis and causes total esophageal dilatation due to esophageal neuromuscular dysfunction. Total esophageal dilatation is also known as megaesophagus. Limited dilatation is due to diverticular bulge. Restricted dilatation of the esophagus, i.e., diverticula, is often divided into two types: bulging (true) diverticula and traction (pseudo) diverticula. The bulging diverticulum is more prominent in the posterior wall, due to the enlargement of the diverticulum in front of the spine sagging, due to the accumulation of food within the diverticulum often compress the esophagus causing stenosis. Traction diverticula are often formed due to chronic inflammation of the tissues surrounding the esophagus (e.g., lymph node tuberculosis) causing scarring contraction and pulling on the esophageal wall, mostly in the anterior wall of the esophagus, which is funnel-shaped and dilated.