Methotrexate and Ulcerative Colitis: Wrong Drug? Wrong Dose? Or Wrong Disease?

2. Pasricha PJ, Ravich WJ, Hendrix TR, Sostre S, Jones B, Kalloo creased esophageal sensory perception. In addition, baAN. Treatment of achalasia with intrasphincteric injection of botusing a separation on the finding of ‘‘vigorous’’ achalasia linum toxin—a pilot trial. Ann Intern Med 1994;121:590–591. in only 10 patients seems premature considering contro3. Pasricha PJ, Ravich WJ, Hendrix TR, Sostre S, Jones B, Kalloo AN. Intrasphincteric botulinum toxin for the treatment of achalasia. N versy over the clinical relevance of this manometric findEngl J Med 1995;332:774–778. ing. However, the dramatic success shown by Pasricha 4. Pasricha PJ, Rai R, Ravich WJ, Hendrix TR, Kalloo AN. Botulinum et al. with this latter category may provide some reasontoxin for achalasia: long-term outcome and predictors of reable justification for its use. sponse. Gastroenterology 1996;110:1410–1415. BoTx injection may well have a role, although limited, 5. Janckovic J, Brin MF. Therapeutic uses of botulinum toxin. N Engl J Med 1991;324:1186–1194. in the treatment of patients with achalasia. However, at 6. Bansal R, Scheiman JM, Barnett JL, Nostrant TT. A randomized present we are distracted by the enthusiasts who are trial of Witzel pneumatic dilatation vs. intrasphincteric injection reaching for their endoscope and injection needle as priof botulinum toxin for achalasia (abstr). Gastroenterology 1995; mary treatment for these patients and ignoring the mar108:A52. 7. Schroeder P, Slaughter R, Torbey C, Morgan D, Koehler R, Richter velous long-term success rate of pneumatic dilatation and J. Treatment of achalasia: botulinum toxin vs pneumatic dilatamyotomy. We hope to temper their zeal by reminding tion. Am J Gastroenterol 1995;90:72. them to review the early enthusiasm, and eventual failure, 8. Katz P. Achalasia: two effective treatment options—let the paof other techniques, such as the Guerin balloon and the tient decide. Am J Gastroenterol 1994;89:969–970. Angelchik prosthesis! 9. Lasch H, Castell DO. Evidence for diminished visceral pain with aging: studies using graded esophageal balloon distension (BD) BoTx injection as long-term therapy for achalasia? To (abstr). Gastroenterology 1994;106:1035. be or not to be? That is the question indeed. 10. Goldenberg SP, Burrell M, Gette GG, Vos C, Traube M. Classic and vigorous achalasia: a comparison of manometric, radioDONALD O. CASTELL graphic, and clinical findings. Gastroenterology 1991;101:743– DAVID A. KATZKA 748. Department of Medicine Graduate Hospital University of Pennsylvania Philadelphia, Pennsylvania