Percorrer por autor "Patita, Marta"
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- Age-related decline in intestinal villus length : a cross-sectional study on the human gutPublication . Vara-Luiz, Francisco; Palma, Carolina; Mendes, Ivo; Piçarra, Francisco; Teles, Ana Elisa; Nogueira, Filipe; Costa-Santos, Inês; Nunes, Gonçalo; Patita, Marta; Mocanu, Irina; Pires, Sara; Meira, Tânia; Vieira, Ana; Pinto-Marques, Pedro; Mascarenhas, Paulo; Leskiv, Iryna; Gomes-Pinto, Daniel; Fonseca, JorgeBackground/Objectives: There is widespread agreement that age is a significant predictor of impaired response to nutritional support. This is generally attributed to anabolic resistance, with impaired absorption considered irrelevant/non-existent. However, animal models demonstrate age-related structural changes in the intestinal mucosa that may reduce absorptive capacity. We aimed to evaluate potential histological changes in the duodenal mucosa associated with aging. Methods: We conducted a single-center observational cross-sectional study. Ambulatory younger (18–45 years) and older (≥70 years) adults referred for upper endoscopy were included and underwent duodenal biopsies. Those biopsies were analyzed and compared for histological/histomorphometric changes, including villus length. Clinical and laboratory data were also recorded. Results: One hundred patients were included (46 men/54 women), 50 aged 18–45 years and 50 aged ≥70 years. There were no duodenal endoscopic changes. The median villus length was 0.35 mm (IQR 0.32–0.41 mm) in older people, lower than in younger adults (0.57 mm; IQR 0.47–0.68 mm) (p < 0.001). In a multivariable regression model including age, sex, and Charlson comorbidity index, age remained inversely associated with villus length (p < 0.001). Older participants also exhibited lower hemoglobin, iron, folate, vitamin B12, albumin and vitamin D levels, despite normal inflammatory markers. Conclusions: Aging is associated with histological changes in the intestinal mucosa, including villus shortening. These findings support the concept of mucosal aging as a distinct biological process. Villus shortening may reflect reduced absorptive surface area and could contribute to age-related nutritional vulnerability, although its functional implications remain to be determined.
- Age-related decline of gastric secretion : facts and controversiesPublication . Vara-Luiz, Francisco; Mendes, Ivo; Palma, Carolina; Mascarenhas, Paulo; Nunes, Gonçalo; Patita, Marta; Fonseca, JorgeAging is associated with structural and functional changes in the gastrointestinal tract; however, its impact on gastric secretion remains unclear. This scoping review examines whether gastric secretion declines with age and explores its clinical implications. Following the PRISMA guidelines, PubMed, Web of Science, Embase, and Google Scholar were systematically searched from inception to December 2024. Fifteen studies (both animal and human) met the inclusion criteria: they were written in English, directly relevant to aging and gastric secretion, and had a clearly stated methodology. Evidence strength was assessed using the GRADE framework, revealing predominantly low to moderate certainty due to small sample sizes and observational study designs. Animal studies have demonstrated reduced acid secretion in older rats, which is attributed to mucosal atrophy and diminished responsiveness to gastrin. Recent human studies suggest that aging does not directly reduce acid output, as reduced acid secretion may result from a higher prevalence of atrophic gastritis, Helicobacter pylori infection, and the widespread use of proton pump inhibitors. Antisecretory therapy may lack benefits in older adult patients with hypochlorhydria/achlorhydria and increase the risk of adverse effects. Pepsin output declines with aging due to reduced chief cell function, although its clinical impact on digestion is unclear. Since intrinsic factor secretion far exceeds the amount necessary for its physiological function, even low amounts seem to be sufficient to prevent cobalamin deficiency. Age-related decline in gastric secretion is mostly attributed to age-associated disorders; however, impairment of secretory function in older people is frequent. Future research should prioritise longitudinal studies, larger cohorts, and histology-stratified analysis.
- Age-related differences in the presentation, management, and outcomes of lower gastrointestinal bleeding : a retrospective multinational cohort studyPublication . Vara-Luiz, Francisco; Palma, Carolina; Mascarenhas, Paulo; Tham, Tony C.; Arvanitakis, Marianna; Rodriguez-de-Santiago, Enrique; Pedroto, Isabel; Simas, Diogo; Radaelli, Franco; Camus, Marine; Gkolfakis, Paraskevas; Triantafyllou, Konstantinos; Fabbri, Carlo; Patita, Marta; Tan, Erica; Campbell, Ellen; Smyth, Michael; Beattie, Hannah; Seeruthun, Ravish; Hadefi, Alia; Rodríguez-Francisco, Gabriela; Paulo, João Pedro; Gonçalves, Luísa; Caetano, Isabel; Savino, Alberto; Goudot, Marie; Panagaki, Antonia; Koukoulioti, Eleni; Nikolaki, Maroulla; Gibiino, Giulia; Gattuso, Alberto; Mendes, Ivo; Piçarra, Francisco; Fonseca, JorgeBackground: Population ageing in Europe is reshaping the clinical profile and outcomes of lower gastrointestinal bleeding (LGIB), but age-related comparative data remain scarce. We aimed to compare clinical presentation, management and 30-day outcomes between older and younger adults with LGIB. Methods: This retrospective, multinational, cohort study included consecutive adults presenting to emergency departments with LGIB between January 1 and December 31 in 2024. European hospitals routinely managing LGIB were eligible to participate. Ethical approval was obtained at hospital level. Patients were categorised in two age groups (≥65 and <65 years). The primary outcome was 30-day mortality. Findings: Overall, 1058 patients from 11 centres in seven European countries were included. Of these, 77.3% (818/1058) were aged ≥65 years and demonstrated a higher Oakland (21.0 ± 7.15), ABC (4.0 ± 2.9), and ALIBI (8.94 ± 3.7) scores, and a higher transfusion rate (50.9%, 416/818). Aetiology differed by age, with anorectal and inflammatory bowel diseases more common in younger adults and diverticular bleeding predominating in older patients. Endoscopy was performed in most patients (84.9%, 899/1058) and the rates of endoscopic therapy, interventional radiology, and surgery were similar across groups. Overall, 30-day mortality was 11.7% (124/1058) and was higher in older adults (13.7%, 112/818 versus 5.0%, 12/240), mainly due to non-bleeding-related causes (89.3%, 100/112). In multivariable analyses, ALIBI score (OR = 1.26 per-point, 95% CI 1.14–1.39), ABC score (OR = 1.25 per-point, 95% CI 1.15–1.36), and Charlson Comorbidity Index (OR = 1.25 per-point, 95% CI 1.14–1.37) were independently associated with 30-day mortality (p < 0.001). Age was inversely associated with intensive care unit admission (OR = 0.95 per-year, 95% CI 0.92–0.98; p = 0.0028). Interpretation: LGIB in older adults presents distinct clinical features with more severe bleeding. Higher baseline vulnerability might explain the age-related differences in escalation of care and worse outcomes. This supports the need for better integrated pathways of care in ageing European populations.
- A challenging case of recurrent cholangitis caused by isolated bile duct metastasis of colorectal adenocarcinoma : rescue therapy through endoscopic ultrasound-guided hepaticoesophagostomyPublication . Vara-Luiz, Francisco; Mendes, Ivo; Nunes, Gonçalo; Palma, Carolina; Patita, Marta; Pinto-Marques, PedroA 64-year-old male was admitted with fever, abdominal pain, and jaundice. Medical history was relevant for colorectal adenocarcinoma 11 years before and right hepatectomy due to liver metastasis. MRCP revealed left hepatic duct stenosis without liver nodules. ERCP was performed for biliary drainage with plastic stents. After inconclusive brush cytology, cholangioscopy (SpyGlass™ DS2) was performed showing villous mucosa surrounded by irregular vessels suggestive of tumor neovascularization. SpyBite™ biopsies confirmed biliary metastasis of colorectal origin. The patient started palliative chemotherapy being readmitted 6 months later with acute cholangitis. Diffuse infiltrating intrabiliary lesion with 120 mm was detected in control MRCP. Given its intraductal extension and gastric compression by the hypertrophied liver leading to duodenoscope mispositioning, transpapilar stents could not be deployed. Multiorgan dysfunction developed despite broad-spectrum antibiotics, and EUS-guided biliary drainage was proposed. Although EUS access was limited by gastric bulging, puncture of a dilated intrahepatic duct was accomplished with a 19G needle. PCSEMS (GIOBOR™ 8 × 100 mm) placement was only possible above the gastroesophageal junction with the proximal flare being incidentally deployed in a 3-cm intraparietal esophageal tract. The misplaced stent was immediately recanalized, and a stent-in-stent FCSEMS (WallFlex™ 80 × 10 mm) allowed the hepaticoesophagostomy creation. Since the stent opening was orally oriented in esophageal lumen, parenteral nutrition was started to avoid contamination. Sepsis recovering and liver test normalization were observed. Before hospital discharge, stent reposition was planned to resume oral feeding. After placement of a third stent-in-stent NCSEMS (WallFlex™ 120 × 10 mm) in the hepaticoesophagostomy to prevent migration, the proximal flare was oriented to the stomach gently pushing with the endoscope aiding by an inflated biliary balloon. The patient resumed chemotherapy but died 8 months after due to disease progression. Isolated bile duct metastasis is an uncommon complication of colorectal cancer. EUS-guided hepaticoesophagostomy is feasible when puncture through the esophagus was inevitable, especially in patients with liver hypertrophy.
- Clinical, endoscopic and histologic differences in gastric mucosa between younger and older adults : an observational study on the aging stomachPublication . Vara-Luiz, Francisco; Mendes, Ivo; Palma, Carolina; Mascarenhas, Paulo; Teles, Ana Elisa; Santos, Inês Costa; Nunes, Gonçalo; Patita, Marta; Mocanu, Irina; Pires, Sara; Meira, Tânia; Vieira, Ana; Pinto-Marques, Pedro; Gomes-Pinto, Daniel; Fonseca, JorgeBackground/Objectives: Age-related changes in the gastric mucosa remain incompletely understood. We aimed to assess and compare clinical, endoscopic and histologic changes in the gastric mucosa associated with aging, and to explore whether gastric aging is associated with a distinct histological pattern. Methods: Single-center observational study. Younger (18–45 years) and older (≥70 years) adults undergoing elective upper endoscopy were included and underwent gastric biopsies. The clinical, endoscopic and histologic features were analyzed and compared. Results: A total of 100 patients were included (45 men/55 women), 50 with 18–45 years and 50 with ≥70 years. Dyspepsia, gastro-esophageal reflux disease and peptic ulcer disease were the most common indications for upper endoscopy. Gastric lesions (erythema, erosions, ulceration and polyps) were more common in older patients (80% vs. 50%, p = 0.003), as well as histologic changes such as chronic gastritis (56% vs. 38%, p = 0.004), chronic atrophic gastritis (CAG; 28% vs. 4%, p < 0.001) and intestinal metaplasia (28% vs. 4%, p < 0.001). These findings persisted after adjusting for Helicobacter pylori (H. pylori) status and proton pump inhibitor intake on the multivariate analysis. Prevalence of H. pylori was similar between both groups (28% vs. 32%, p = 0.189). Conclusions: Aging is associated with clinical, endoscopic and histologic changes in the gastric mucosa including CAG and metaplasia, independent of the presence of H. pylori. These findings may result from several aging-related pathophysiological processes and decades of cumulative gastric injury and support the hypothesis of an aging stomach phenotype, underscoring the need for an age-adjusted interpretation of gastric biopsies.
- Endoscopic gastrostomy for nutritional support in post-stroke dysphagiaPublication . Patita, Marta; Nunes, Gonçalo; Grunho, Miguel; Santos, Carla Adriana; Fonseca, JorgeIntroduction: persistent dysphagia affects 15 % of stroke patients and contributes to malnutrition, aspiration, and death. This study aimed to characterize patients with post-stroke dysphagia who underwent percutaneous endoscopic gastrostomy (PEG), and to assess the impact of PEG feeding on nutritional status and outcome. Methods: an observational and retrospective study using records from patients with post-stroke dysphagia who underwent PEG. Body mass index (BMI), serum albumin, transferrin, and cholesterol were recorded at the time of PEG insertion (T0) and 3 months later (T3). The evolution of these parameters was analyzed and compared to survival. Results: we obtained data from 158 patients (53.2 % males) with a median age of 75 years. Most strokes were ischemic (n = 135, 85.4 %). Median time between stroke and PEG was 2 months. Median survival after gastrostomy was 16 months. At admission, 41.6 % of patients had low BMI, 62.3 % low albumin, 68.6 % low transferrin, and 59.6 % low cholesterol levels. The prevalence of low albumin and low transferrin was higher in the patients who underwent PEG more than 2 months after stroke. A significant increase in albumin and transferrin, and a normalization of cholesterol levels was observed after 3 months of PEG feeding. Mortality was 12.9 %, 27.7 %, and 40 % at 1, 3, and 12 months, respectively. Survival was lower in patients with low albumin, transferrin or total cholesterol at admission. Conclusions: the prevalence of malnutrition is high among patients with post-stroke dysphagia. PEG feeding improves albumin, transferrin, and cholesterol levels. Early post-PEG mortality is high and must be considered on an individual basis.
- Endoscopic treatment of bile duct stones after bariatric Roux-en-Y gastric bypass through endoscopic ultrasound-directed transgastric ERCPPublication . Vara-Luiz, Francisco; Nunes, Gonçalo; Pinto-Marques, Pedro; Oliveira, Carla; Mendes, Ivo; Patita, Marta; Fonseca, JorgeEndoscopic retrograde cholangiopancreatography (ERCP) is technically challenging after Roux-en-Y gastric bypass (RYGB) [1]. Standard approaches include enteroscopy-assisted and laparoscopy-assisted ERCP, which present difficult implementation in clinical practice [2]. The authors report endoscopic ultrasound-directed transgastric ERCP (EDGE) for the treatment of bile duct stones in RYGB patients ([Video 1]).
- Endoscopic ultrasound-guided cholecystoduodenostomy followed by stone clearance using electrohydraulic and mechanical lithotripsy in a frail patient with acute cholecystitisPublication . Vara-Luiz, Francisco; Mendes, Ivo; Nunes, Gonçalo; Palma, Carolina; Patita, Marta; Fonseca, Jorge; Pinto-Marques, Pedro
- First case report of pancreatic angiomyolipoma diagnosed by EUS-guided fine-needle biopsyPublication . Vara-Luiz, Francisco; Patita, Marta; Pinto-Marques, Pedro; Mendes, Ivo; Canastra, Ana Ramos
- First case report of pancreatic angiomyolipoma diagnosed by EUS-guided fine-needle biopsyPublication . Vara-Luiz, Francisco; Patita, Marta; Pinto-Marques, Pedro; Mendes, Ivo; Canastra, Ana Ramos