Mahinaz Mohsen

Barrett's esophagus (BE) and achalasia are distinct esophageal disorders with opposing pathophysiologic mechanisms, making their coexistence exceedingly rare. We describe a 51‐year‐old woman who presented with progressive dysphagia, postprandial vomiting, and significant weight loss over 8 months.

Background and Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely linked to systemic cardiometabolic dysfunction. Resting heart rate (RHR), a marker of autonomic and metabolic stress, has been associated with metabolic syndrome and cardiovascular disease, though its relationship with MASLD remains incompletely characterized. We evaluated the association between RHR and liver-related outcomes in a nationally representative U.S. cohort. Materials and Methods: We analyzed adults aged 20–79 years from NHANES 2017–2020 with valid vibration-controlled transient elastography (VCTE) measurements. Participants with significant alcohol use, viral hepatitis, pregnancy, use of heart rate-modifying medications, or missing key data were excluded. Liver outcomes included elevated alanine aminotransferase (ALT), advanced steatosis (CAP ≥ 290 dB/m), FIB-4 fibrosis category, and VCTE-defined fibrosis. Multivariable regression models adjusted for demographic and metabolic covariates were used to evaluate associations between RHR and liver-related outcomes. Results: A total of 3532 adults were included. Each 1 beat-per-minute increase in RHR was independently associated with elevated ALT (OR 1.025, 95% CI 1.002–1.050, p = 0.043) and advanced steatosis (OR 1.036, 95% CI 1.001–1.073, p = 0.048). No significant association was observed between RHR and higher FIB-4 category (OR 1.025, 95% CI 0.992–1.060, p = 0.169) or VCTE-defined fibrosis (OR 0.990, 95% CI 0.961–1.021, p = 0.481). Associations with ALT and steatosis were attenuated after adjustment for glycemic and lipid parameters. Conclusions: Higher RHR was associated with steatosis-related and metabolic liver outcomes, but not fibrosis, in a nationally representative cohort. These findings suggest that RHR may reflect underlying autonomic and metabolic dysfunction relevant to early MASLD pathogenesis rather than advanced fibrotic disease.

We present a case of near-complete upper esophageal obstruction secondary to radiation necrosis in a patient with a history of hypopharyngeal squamous cell carcinoma treated with radiation and cisplatin/docetaxel chemotherapy. Standard endoscopic passage was not possible due to the absence of a visible lumen. An ERCP (endoscopic retrograde cholangiopancreatography) guidewire was advanced across the stenosis with moderate resistance, and using the wire as a guide, an ultrathin endoscope (4.9 mm; Olympus Corporation, Tokyo, Japan) was used as a dilator, achieving successful dilation to 10 mm and enabling passage into the middle third of the esophagus. Following the procedure, the patient tolerated a liquid diet and gained 13 pounds. Unlike prior reports in which the ultrathin endoscope served as an access tool followed by separate mechanical dilation or combined antegrade-retrograde dilation (CARD), in this case, the ultrathin endoscope itself functioned as the dilator, simplifying the procedure. This case highlights a resource-efficient approach to managing esophageal obstruction with an ultrathin endoscope as the dilator, offering a practical alternative in settings without access to fluoroscopy, stenting, or advanced interventional equipment. This technique may be most applicable to early inflammatory strictures rather than mature fibrostenotic ones. Findings are preliminary and based on a single case; further prospective studies are needed to establish safety, efficacy, and long-term outcomes.

Background and Aims; Metabolic dysfunction–associated steatotic liver disease (MASLD) is closely linked to systemic cardiometabolic dysfunction. Resting heart rate (RHR), a marker of autonomic and metabolic stress, has been associated with metabolic syndrome and cardiovascular disease, though its relationship with MASLD remains incompletely characterized. We evaluated the association between RHR and liver-related outcomes in a nationally representative U.S. cohort. Materials and Methods; We analyzed adults aged 20–79 years from NHANES 2017–2020 with valid vibration-controlled transient elastography (VCTE) measurements. Participants with significant alcohol use, viral hepatitis, pregnancy, beta-blocker use, or missing key data were excluded. Liver outcomes included elevated alanine aminotransferase (ALT), advanced steatosis (CAP ≥290 dB/m), FIB-4 fibrosis category, and VCTE-defined fibrosis. Multivariable regression models adjusted for demographic and metabolic covariates were used to evaluate associations between RHR and liver-related outcomes. Results; A total of 3,567 adults were included. Each 1 beat-per-minute increase in RHR was independently associated with elevated ALT (OR 1.025, 95% CI 1.002–1.050, p=0.026) and advanced steatosis (OR 1.036, 95% CI 1.001–1.073, p=0.033). No significant association was observed between RHR and higher FIB-4 category (OR 1.025, 95% CI 0.992–1.060, p=0.150) or VCTE-defined fibrosis (OR 0.990, 95% CI 0.961–1.021, p=0.511). Associations with ALT and steatosis were attenuated after adjustment for glycemic and lipid parameters. Conclusions; Higher RHR was associated with steatosis-related and metabolic liver outcomes, but not fibrosis, in a nationally representative cohort. These findings suggest that RHR may reflect underlying autonomic and metabolic dysfunction relevant to early MASLD pathogenesis rather than advanced fibrotic disease.

Primary Biliary Cholangitis (PBC) is a chronic, immune-mediated cholestatic liver disease characterized by progressive intrahepatic bile duct destruction, leading to pruritus, fatigue, cirrhosis, and eventually hepatocellular carcinoma. Early diagnosis has improved with the development of sensitive serologic assays (e.g., antimitochondrial antibodies, antinuclear antibodies) and the introduction of newer biomarkers. Risk stratification has become standardized with the help of GLOBE and UK-PBC scores, alongside non-invasive tools such as vibration-controlled transient elastography, enabling earlier intervention. Ursodeoxycholic acid (UDCA) is the first-line therapy; however, 30–40% of patients show an incomplete response, increasing their risk of liver failure and mortality. Second-line therapies have emerged which provide viable treatment avenues for those who do not respond to UDCA or are unable to tolerate it. However, in certain situations, such as decompensated cirrhosis, carcinoma, or refractory pruritus, liver transplantation constitutes the only curative therapy. While PBC has excellent post-liver transplant (post-LT) outcomes, patients with PBC face higher waitlist mortality as they tend to have lower MELD scores. Management post-LT includes the use of UDCA, immunosuppressants, and surveillance for recurrent PBC. Our review highlights the recent advances in medical management and transplant risk stratification of patients at risk of decompensation, as well as the perioperative transplant period outcomes and long-term post-transplant management strategies in patients with PBC.

Background: Chronic hepatitis D virus (HDV) continues to be a global health concern, and the infection remains challenging to treat. Over the past few decades, pegylated interferons, typically in combination with therapy for hepatitis B, have become the standard of care, with considerable side effects and frequently unsatisfactory results. Several new therapies are emerging, including bulevirtide and lonafarnib. We conducted a systematic review and network meta‐analysis (NMA) to compare the efficacy of bulevirtide, interferons, and nucleos(t)ide analogs, alone or in combination, for the treatment of chronic hepatitis D. Methods: PubMed, Embase, and Cochrane databases were searched for randomized controlled trials and nonrandomized interventional studies assessing HDV RNA suppression, biochemical response, combined response, and histological improvement with various therapies. NMA was performed using a frequentist random‐effects model. Odds ratios (OR) with 95% confidence intervals (CI) were calculated and forest plots were generated. Results: Thirteen studies ( n = 922) were included, studying nine possible treatment arms. At the end of treatment, 31.8% achieved a virological response. Bulevirtide monotherapy (OR 38.63, p < 0.05) and combinations with NA (OR 69.36, p < 0.05) and peginterferon alpha (OR 260.08, p < 0.05) significantly suppressed HDV RNA, with the bulevirtide–peginterferon alpha combination having the highest HDV RNA suppression. At ≥ 24‐week follow‐up, no regimen maintained significant HDV RNA suppression. Biochemical response was achieved in 42.7% at the end of treatment; however, no group reached statistical significance versus control, though bulevirtide and its combination with peginterferon alpha outperformed peginterferon alpha alone. Combined response was highest with bulevirtide–peginterferon alpha (OR 112.69, p < 0.05), followed by bulevirtide monotherapy. Histological response (five studies, n = 183) was not statistically significant with any intervention compared with control. Conclusion: Bulevirtide and peginterferon alpha combination therapy may offer the most promising treatment for chronic hepatitis D. More studies are needed to assess the efficacy of this regimen and establish the optimum dose and duration of treatment.

Metabolic-associated steatotic liver disease is currently one of the most common causes of liver disease in the world, affecting a large portion of the global population; these patients are at risk of developing advanced liver fibrosis and cirrhosis. Noninvasive tests (NITs), including lab tests such as FIB-4, NAFLD Fibrosis Score and the Aspartate Aminotransferase-to-Platelet Ratio Index, are widely used for fibrosis risk stratification, but their accuracy across various racial, ethnic, and age groups remains poorly characterized. This review examines disparities in NIT performance across these populations and the need for tailored screening strategies. A comprehensive, narrative literature review highlighted significant variability in NIT performance, with studies in African American, Hispanic and Asian patients all revealing mixed results when the performance of NITs was used to assess fibrosis levels. Additionally, the age of patients may influence fibrosis testing, as older adults tend to have higher false-positive rates due to age-based biases. Although imaging modalities like VCTE and MRE may offer superior accuracy in the noninvasive assessment of hepatic fibrosis, they face accessibility limitations and have rarely been validated in specific racial groups. This review concludes that current NITs for MASLD risk stratification needs to be recalibrated with population-specific and age-adjusted thresholds, and future research should focus on inclusive validation studies and integrating clinical judgment to improve screening accuracy.