Introduction: FORESTIER disease-an unusual cause of dysphagia is a common presenting complaint in otolaryngology, internal medicine, and neurology practice, which has many known causes. FORESTIER disease or DISH is a rare but curable cause of dysphagia. DISH (diffuse idiopathic skeletal hyperostosis) is a rheumatic abnormality characterized by exuberant proliferation of bone at osseous sites of ligamentous and tendinous attachments throughout the body. A higher prevalence is found among diabetics and males. The incidence of DISH increases with aging. Presenting features include dysphagia, dyspnea, hoarseness, aspiration pneumonia, myelopathy, and entrapment neuropathy. Methods: A sixty-year-old man with complaint of progressive dysphagia to solid food for 6 years underwent barium swallow examination and cervical x-ray showed diffuse ligament calcification and osteophytes protrusion and compression of the esophagus.Conclusions: The patient underwent conservative treatment with non-steroidal anti-inflammatory drugs (NSAIDS) but was then referred for surgical intervention because no favorable clinical response was seen.

Introduction: Zenker's diverticulum is an acquired sac-like outpouching of the mucosa and submucosa layers originating at the pharyngoesophageal junction. The predominant symptom of Zenker’, s diverticulum is dysphagia. Videofluoroscopy confirms the diagnosis. FORESTIER disease is a clinical entity characterized by ossification of anterolateral vertebral ligament and anterior osteophyte formation along the anterolateral spinal column. Its etiopathogenesis remains unknown and common symptoms are dysphagia, dysphonia and airway obstruction. The objective of this study is to identify a pathophysiological correlation between FORESTIER disease and the onset of Zenker’, s diverticulum. Materials and Methods: A retrospective observational study was conducted. The electronic database of our Radiology Unit was analyzed in order to identify patients with hypopharyngeal diverticulum and osteophytes at the cervical vertebrae level, from January 2010 to January 2021. The search was performed using precise keywords. Results: The computerized database search outlined 10 imaging exams: 5 videofluorographies and 5 computed tomography scans. In 100% of the cases, dysphagia was the main symptom that led to the diagnostic assessment,30% of patients, on the other hand, reported dyspnoea. From the data analysis, the male / female ratio is 1: 1 and the average age of the patients is 64. 8 (+/-11. 31) years. Conclusions: We assume that the anatomical abnormalities in FORESTIER disease may cause an increase of pharyngeal pressure and consequently support the development of the Zenker’, s diverticulum. Hence, it is always recommended to investigate the presence of Zenker’, s diverticulum in a patient with FORESTIER disease, especially for the lifethreatening complications of Zenker's diverticulum.

We enjoyed reading the excellent article by Yilmaz and colleagues on noninvasive assessment of liver fibrosis using aspartate transaminase to platelet ratio index (APRI) in adult patients with chronic liver disease (CLD) (1). They performed their tests on adults with chronic hepatitis C (CHC), B (CHB), and non-alcoholic fatty liver disease (NAFLD).We definitely need to develop serological markers that have satisfactory sensitivity, specificity, and high predictive values, which can be used either instead of liver biopsy or to reduce the frequency of needed biopsies for monitoring the evolution of CHC and defining the right moment for commencing treatment. Despite the study results showing that APRI has an acceptable accuracy for the assessment of liver fibrosis in adults with CHC and NAFLD, this was not the case in CHB patients. We believe that the study results would have been more valid if the researchers have used a combination of non-invasivetests to assess liver fibrosis. A similar study conducted in Hungary used APRI and liver stiffness (LS) measurements to assess fibrosis in CHC (2). The combination of both fibrosis markers was useful for non-invasive assessment of fibrosis in CHC. FORESTIER and colleagues found that LS measurements, APRI score, 13C-amniopyrine breath test and indocyanine green plasma clearance were reliable markers for assessing cirrhosis in patients with CLD (3).APRI was also found to be a simple and readily available tool for assessing liver fibrosis in patients with biliary atresia during post-operative follow-up care (4).