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The treatment of chronic hepatitis C has been a challenge to most hepatologists and gastroenterologists. Approximately half of the patients demonstrate a response at the end of treatment with standard interferon (IFN) therapy. Of these responders, only half will eventually have sustained responses 6 months after the end of treatment. 1-3 There appear to be 2 challenges to achieving responses to IFN therapy in hepatitis C virus (HCV). The first is to initiate an antiviral response, and the second is to maintain the response after therapy and prevent a relapse. Longer IFN treatment durations, i.e., 12 to 18 months rather than 6 months, increases the chance of a sustained response. 4 However, the former issue of how to increase the initial response rate has not been resolved, although ''induction'' therapy may enhance initial IFN responsiveness. The issue of initial response rate is further complicated by the phenomenon of breakthroughs. A breakthrough occurs when a patient achieves a response while on IFN therapy and then loses the response despite continued IFN therapy. Breakthroughs have largely been defined by a transient normalization of alanine transaminase (ALT) values, because ALT has been the primary measure of efficacy in most HCV clinical trials. However, sensitive assays to measure HCV RNA have now become the standard in assessment of efficacy. Thus, patients could have either an ALT breakthrough or an HCV-RNA breakthrough. The latter would be a transient undetectable serum HCV-RNA value that returns to detectable levels during continued IFN Abbreviations: IFN, interferon; HCV, hepatitis C virus; ALT, alanine transaminase; CIFN, consensus interferon.From the

Oesophageal function has been studied in three groups of cirrhotic patients: those without varices, those with varices and those with varices treated by injection sclerotherapy. Using the Honeywell Model 31 oesophageal motility probe and the Ingold combined stomach pH electrode, measurements were made of the lower oesophageal sphincter (LES) pressure and length, swallowing responses, reflux and clearance of acid. The presence of varices was associated with an increase in LES length and reduced lower oesophageal contraction pressure during swallowing and some failure of sphincter relaxation during swallowing. Sclerotherapy was associated with a reduction in the maximum LES pressure both at rest and during swallowing, and an impairment of acid clearance, but postural reflux of acid was not observed in any patient.