Significant hepatic fibrosis and necroinflammation can reliably be predicted using routinely checked tests and HBV DNA levels.

Background: HBV infection is a serious global heath problem. It is crucial to monitor this disease more closely with a non-invasive marker in clinical trials. We aimed to evaluate the predictive value of serum hyaluronate for the presence of extensive liver fibrosis and inflammation.

INTRODUCTIONAchalasia is a primary oesophageal motor disorder characterized by incomplete relaxation of the lower oesophageal sphincter on swallowing and aperistalsis of the oesophageal body.1 Histopathological examination of the achalasic oesophagus demonstrates a loss of inhibitory myenteric plexus ganglionic cells. The loss of inhibitory ganglion cells secreting nitrous oxide and vasoactive intestinal peptide and the persistence of cholinergic stimulatory cells appear to be the primary pathophysiological defects.2 The mainstay of therapy is directed towards the reduction of lower oesophageal sphincter pressure resulting in improved oesophageal emptying by gravity. Pharmacological therapy, endoscopic dilatation, botulinum toxin injection and surgical myotomy are the primary therapeutic modalities. Pneumatic balloon dilatation is a commonly used treatment modality. Studies have found that balloon dilatation provides good to excellent symptomatic relief in 86±100% of cases. 3±6 In a large prospective study, Barkin et al. reported that dilatation with a 3.5-cm balloon provided symptomatic response in 90% of patients. 6 The advantages of this technique include the opportunity for a 1-day out-patient procedure, SUMMARY Background: Therapeutic options for achalasia include pharmacological therapy, surgical myotomy, pneumatic dilatation and intrasphincteric botulinum toxin injection. Aim: To compare botulinum toxin injection with pneumatic dilatation in a randomized trial. Patients/methods: Forty adults with newly diagnosed achalasia were randomized to receive botulinum toxin (n 20) or pneumatic dilatation (n 20). Symptom scores were evaluated at 1, 6 and 12 months. Clinical relapse was de®ned as a symptom score greater than 50% of baseline. Relapsers received a second botulinum toxin injection or pneumatic dilatation. Results: The cumulative 12-month remission rate was signi®cantly higher after a single pneumatic dilatation

Background: Pneumatic dilatation is considered to be the first line therapy for achalasia, but long-term outcome studies are scarce and limited by their retrospective design. There is also no consensus on the optimal method for performing pneumatic dilation as regard to balloon diameter, amount and the rate inflation pressure. Aim: To address these questions in a large long-term prospective study.