Introduction: Limited access to esophageal motility (EM) may delay achalasia patient identification and treatment. In order to assess predictors to fast-track patients for manometric confirmation of achalasia, we compared the clinical, radiographic and endoscopic characteristics of achalasia patients (AP) to non-achalasia dysphagic controls (C). Methods: Patients referred for EM to assess functional dysphagia from 2/04 to 2/05 were asked to participate in this prospective study. The Achalasia Symptom Questionnaire (ASQ), a structured 11-question survey (score:0-best,67-worst), was completed by all consenting patients. ASQ scores, esophago-gastro-duodenoscopy (EGD), upper GI contrast study (UGI) were compared between patents with subsequently confirmed achalasia (AP) and those in whom achalasia was excluded by EM (C). Data presented as mean ± SD; Univariate analysis (t-test and Chi-square) identified predictors that were tested in multivariate logistic regression to generate the model. (* p<0.05). Results: Of 803 EM performed from 2/04-2/05, 95 patients were referred specifically to rule out achalasia. 50 APs and 45 Cs were identified. ASQ scores were higher in AP (37±13 vs 23±10)*. EGD and/or UGI reports were available in 92% APs and 80% Cs. Significant predictors for achalasia with odds ratios are presented in the table. Probability of achalasia is predicted by P where P=e^y/(1+e ^y) and y=-5.6+(0.089xASQ) +(2.088 x EGD) + (3.083xUGI), e=exponential constant 2.7182, EGD and UGI = 0 if normal and 1 if abnormal. For a given patient with ASQ >40, abnormal UGI and EGD the probability of achalasia is >96%, if ASQ <30 with normal UGI and EGD probability is less than 5% for achalasia. Conclusions: Achalasia can be accurately predicted in patients with functional dysphagia based on clinical, endoscopic, and radiographic findings allowing for a prioritization of esophageal motility.