A 66‐year‐old man with remote history of liver transplantation for nonalcoholic steatohepatitis cirrhosis, surgical repair of hiatal hernia (HH), and methylenetetrahydrofolate reductase (MTHFR) gene mutation on warfarin presented to the emergency department with acute onset chest and epigastric pain, shortness of breath, and melena. This evidence concerns the gene MTHFR and Hiatus hernia.