In view of the unknown aetiology of achalasia and diffuse oesophageal spasm we report four families (father/son, mother/son, brother/brother, cousin/cousin) with achalasia and oesophageal spasm examined by radiology, endoscopy and manometry. Family occurrence of oesophageal motor disorders supports the hypothesis that a genetic trait may play a role in the pathogenesis. The family coincidence of achalasia and oesophageal spasm supports a close relationship between the two diseases.

Recently, oenological prejudices were challenged by the use of a points scoring system (from 50 to 100) to evaluate wine in a book now widely regarded as one of the most authoritative. On this scale, a 1981 Chateau Citran described as 'emaciated' scored 65, a 1983 Chateau Kirwan scored 85, and a 1982 Petrus 100. If the same approach were used for drugs used in ulcerative colitis to quantify an advance over conditions existing at the time of its introduction how would they score? Because they were the first available drugs in their class and clearly constituted major advances, corticosteroids and sulphasalazine both score 95, the score being limited by a high level of side effects. The new salicylates score 75, because they extend the benefits of sulphasalazine to a minority of patients but they have the potential to score 90 if increased dosing and greater effectiveness over sulphasalazine can be achieved. Salicylate enemas score 80, because they advance treatment over topical corticosteroids for patients with resistant distal disease, but the mode of delivery needs improvement. Steroid foams also score 80, particularly if the patient's vote is taken into account. Azathioprine's score cannot be calculated because there is doubt over its efficacy, but it is potentially 88 if it saves patients with difficult disease from colectomy. We can only guess what an oral non-absorbed steroid would score, but if response rates for relapse were substantially improved, or if corticosteroids could be used as effective maintenance treatment, it could be as high as 95. There are indications that we should 'watch this space'.

The sixth documented case of heterotopic gastric mucosa in the large bowel proximal to the rectum is described in a two year old girl with a neural tube defect and recurrent rectal bleeding. Unusual in itself, this case is unique in that the rectal bleeding has been controlled with an H2 receptor antagonist.

A case involving a gastric carcinoid in association with parathyroid adenoma is reported and the question of a possible link between these two ailments is discussed.