Mário Dinis-Ribeiro

University of Porto, Oporto, Porto, Portugal

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Publications (144)547.26 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The presence of lymph node (LN) metastasis is a key prognostic factor for gastric adenocarcinoma. However, even among patients without LN metastasis (N0), recurrence may occur. In some of these cases, occult tumor cells (OTC) are thought to play an important role. We aimed to determine the prevalence of OTC and its clinical relevance. We conducted a systematic review of studies in English published until September 2013 that addressed OTC prevalence and/or its clinical relevance. The studies were retrieved from the MEDLINE database. We included 42 studies. The most frequently used methods for detecting OTC were immunohistochemical examination (IHC) and/or polymerase chain reaction (PCR) with a wide range of markers. Using IHC for OTC detection, in patients and in LN, the prevalence varied from 9 to 88% and 0.4 to 42%, respectively. With PCR, it ranged from 17 to 46% in patients, and from 3 to 33% in LN. In the studies assessing the predictive role of OTC in gastric cancer recurrence (n = 24), 8 studies found no statistical association, while 18 concluded that OTC presence was associated with poorer prognosis. However, only 6 studies presented a significantly different 5-year survival rate between patients with and without LN micrometastasis. OTC seems to occur in gastric cancer patients with a variable prevalence, depending on the definition, methods and setting. The majority of the retrieved studies (75%) evaluating the predictive role of OTC conclude that its presence is associated with a worse prognosis. © 2015 S. Karger AG, Basel.
    Oncology 07/2015; DOI:10.1159/000433543 · 2.61 Impact Factor
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    ABSTRACT: Helicobacter pylori exploits host glycoconjugates to colonize the gastric niche. Infection can persist for decades promoting chronic inflammation, and in a subset of individuals lesions can silently progress to cancer. This study shows that H. pylori chronic infection and gastric tissue inflammation result in a remodeling of the gastric glycophenotype with increased expression of sialyl-Lewis a/x antigens due to transcriptional up-regulation of the B3GNT5, B3GALT5, and FUT3 genes. We observed that H. pylori infected individuals present a marked gastric local pro-inflammatory signature with significantly higher TNF-α levels and demonstrated that TNF-induced activation of the NF-kappaB pathway results in B3GNT5 transcriptional up-regulation. Furthermore, we show that this gastric glycosylation shift, characterized by increased sialylation patterns, favors SabA-mediated H. pylori attachment to human inflamed gastric mucosa. This study provides novel clinically relevant insights into the regulatory mechanisms underlying H. pylori modulation of host glycosylation machinery, and phenotypic alterations crucial for life-long infection. Moreover, the biosynthetic pathways here identified as responsible for gastric mucosa increased sialylation, in response to H. pylori infection, can be exploited as drug targets for hindering bacteria adhesion and counteract the infection chronicity. Copyright © 2015. Published by Elsevier B.V.
    Biochimica et Biophysica Acta 07/2015; DOI:10.1016/j.bbadis.2015.07.001 · 4.66 Impact Factor
  • Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 06/2015; 107. DOI:10.17235/reed.2015.3721/2015 · 1.32 Impact Factor
  • Mário Dinis-Ribeiro, Ernst J Kuipers
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    ABSTRACT: In an aging European population, an increasing number of individuals will suffer from gastric cancer in the coming two decades. Recent research has determined the risk for gastric cancer in patients with different stages of gastric atrophy. Based on these data, it is now recommended that surveillance is offered to individuals with advanced stages of atrophic gastritis. Endoscopic biopsies of the gastric antrum and corpus are recommended in order to assess the severity and extent of gastric atrophy. This enables identification of those at highest risk of progressing to cancer. However, systematic reviews have shown that in recent years many researchers have assessed new endoscopic technologies for their accuracy in determining the severity and extent of gastric atrophy and metaplasia without the use of histology. Simple, reliable and accurate endoscopic features have been identified that can be used to either target biopsies or avoid biopsy sampling in the absence of endoscopic features of atrophy and intestinal metaplasia. This may largely simplify everyday practice. Randomized trials or large observational studies are now needed to demonstrate the accuracy of endoscopic assessment of the entire gastric mucosa and its impact on patient management. © Georg Thieme Verlag KG Stuttgart · New York.
    Endoscopy 05/2015; 47(06). DOI:10.1055/s-0034-1392151 · 5.20 Impact Factor
  • Gastrointestinal Endoscopy 05/2015; 81(5):AB125. DOI:10.1016/j.gie.2015.03.031 · 4.90 Impact Factor
  • Gastrointestinal Endoscopy 05/2015; 81(5):AB463. DOI:10.1016/j.gie.2015.03.1668 · 4.90 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-555-S-556. DOI:10.1016/S0016-5085(15)31868-0 · 13.93 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-63. DOI:10.1016/S0016-5085(15)30218-3 · 13.93 Impact Factor
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    ABSTRACT: Endoscopic submucosal dissection (ESD), an endoscopic technique used for treatment of gastric superficial lesions, has been gaining importance on western countries. Procedural times have an impact on various outcomes.
    03/2015; 17(2). DOI:10.1016/j.jpge.2015.01.002
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    ABSTRACT: Data on the burden of gastrointestinal diseases are incomplete, particularly in Southern European countries. The aim of this study was to estimate the burden of digestive diseases in Portugal. This was a retrospective observational study based on the national hospitalizations database that identified all consecutive episodes with a first diagnosis of a digestive disease between 2000 and 2010 using ICD-9-CM codes. Comparative analyses were carried out to assess hospitalization trends of major indicators over time and across regions. More than 75 000 deaths attributable to digestive diseases were observed, representing 16% of the overall in-hospital mortality. Over half of these (59%) were premature deaths (in patients <75 years of age). Biliary tract disease was the most common digestive disorder leading to hospitalization (249 817 episodes, 5210 episodes of acute stone-related cholecystitis in 2010, with an 11% increase compared with 2000). Gastric cancer was responsible for the highest number of in-hospital deaths (10 278) and alcohol-related liver disorders accounted for the highest in-hospital premature deaths (7572). Both costs and the in-hospital mortality rate for major digestive diseases showed a significant positive relation with progression of time (β=0.195, P<0.001); however, when adjusted for age, this was not significant. Significant positive associations were found between age and in-hospital mortality (odds ratio=1.032, P<0.001) and between costs and in-hospital mortality (odds ratio=1.054, P<0.001). In Portugal, digestive diseases represent a major burden, with evidence of an increasing trend. An ageing population contributes strongly towards this increase, placing further demands on healthcare organizations. Diseases such as gastric cancer, biliary tract disease and alcohol-related liver disorders may require particular attention.
    European Journal of Gastroenterology & Hepatology 03/2015; 27(3):279-89. DOI:10.1097/MEG.0000000000000266 · 2.15 Impact Factor
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    ABSTRACT: National surveys have been used to obtain information on sedation and monitoring practices in endoscopy in several countries. To provide data from Portugal and query the Portuguese endoscopists on nonanesthesiologist administration of propofol. A 31-item web survey was sent to all 490 members of the Portuguese Society of Gastroenterology. A total of 129 members (26%) completed the questionnaire; 57% worked in both public and private practice. Most performed esophagogastroduodenoscopy without sedation (public - 70%; private - 57%) and colonoscopies with sedation (public - 64%; private - 69%). Propofol was the most commonly used agent for colonoscopy, especially in private practice (52 vs. 33%), and it provided the best satisfaction (mean 9.6/10). A total of 94% chose propofol as the preferred sedation for routine colonoscopy. Nonanesthesiologist administration of propofol was performed only by four respondents; however, 71% reported that they would consider its use, given adequate training. Pulse oximetry is monitored routinely (99%); oxygen supplementation is administered by 81% with propofol and 42% with traditional sedation. Most (82%) believed that propofol sedation may increase the uptake of endoscopic screening for colorectal cancer. The use of sedation is routine practice in colonoscopy, but not esophagogastroduodenoscopy. The preferred agent is propofol and it is used almost exclusively by anesthesiologists.
    European Journal of Gastroenterology & Hepatology 03/2015; 27(3):265-70. DOI:10.1097/MEG.0000000000000245 · 2.15 Impact Factor
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    ABSTRACT: Abstract Background. Most countries lack a well-coordinated approach to out-of-hours endoscopy. Economic constraints and lack of resources have been identified as important barriers. Objective.To assess the performance evaluation of an out-of-hours emergency endoscopy model of care. Design. During a 3 year period (January 2010 to December 2012), data from consecutive outpatients (n = 332) with non-variceal acute upper gastrointestinal bleeding admitted or transferred to a single referral hospital were prospectively collected. Results. 34% (n = 113) were direct admissions whereas 66% (n = 219) were transferred from other hospitals. Median time to upper endoscopy esophagogastroduodenoscopy (EGD) was 6 h and 7.7 h for direct admissions and transferred, respectively. EGD was performed within 24 h in 90% of the patients. Rebleeding, in-hospital mortality, 30 day mortality and need for surgery were respectively 9.8%, 5.8%, 7.4%, and 6.6% and were not significantly different between the two groups. Age, malignancy, and moderate to high clinical Rockall risk score were independent predictors of in-hospital mortality in both groups. Age remained as an important predictor of main outcomes in transferred patients, while comorbidities differed according to admission status and predictable outcomes. Conclusion.This gastroenterology emergency model improved access and equity to out-of-hours endoscopy in an effective, safe, and timely way, recognized by the rates and the homogeneity observed in the outcomes, between transferred patients and direct admissions.
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    ABSTRACT: Gastric cancer is a serious disease that most people usually do not know they have until they start to get symptoms. Gastroenterology imaging is an essential tool for this battle, since an early diagnosis typically leads to a good prognosis. However, this is a rapidly evolving technological area with novel imaging devices such as capsule, narrow-band imaging or high-definition endoscopy. Adapting to these technologies has a high time-price cost, even for experienced clinicians, motivating the appearance of interactive environments that can accelerate these training processes. The GEMINI (Gastroenterology Made Interactive) project aims to create an interactive clinical decision support system (CDSS) that can be used to help with the diagnosis within a gastroenterology room during real endoscopic examinations. We used human computer interaction (HCI) support methodologies in order to identify interaction opportunities. As a final conclusion, the most promising avenue for interactions with CDSS is probably using mobile devices such as tablets, controlled by a nurse at the physician's request. As future work, we will prototype and evaluate such a system in a real hospital environment.
    Studies in health technology and informatics 01/2015; 210:652-6.
  • M. Serrano, I. Kikuste, M. Dinis-Ribeiro
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    ABSTRACT: The most immediate strategy for improving survival of gastric cancer patients is secondary prevention through diagnosis of early gastric cancer either through screening or follow-up of individuals at high risk. Endoscopy examination is therefore of paramount importance and two general steps are to be known in assessing gastric mucosa – detection and characterization. Over the past decade, the advent of advanced endoscopic imaging technology led to diverse descriptions of these modalities reporting them to be useful in this setting. In this review, we aim at summarizing the current evidence on the use of advance imaging in individuals at high-risk (ie, advance stages of gastric atrophy/intestinal metaplasia) and in those harboring neoplastic lesions, and address its potential usefulness providing the readers a framework to use in daily practice. Further research is also suggested.
    Baillière&#x027 s Best Practice and Research in Clinical Gastroenterology 12/2014; DOI:10.1016/j.bpg.2014.10.002 · 3.28 Impact Factor
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    ABSTRACT: A recent review of economic studies relating to gastric cancer revealed that authors use different tests to estimate utilities in patients with and without gastric cancer. Our aim was to determine the utilities of gastric premalignant conditions and adenocarcinoma with a single standardized health measure instrument. Cross-sectional nationwide study of patients undergoing upper endoscopy (n=1,434) using the EQ-5D-5L quality of life (QoL) questionnaire. According to EQ-5D-5L, utilities in individuals without gastric lesions were 0.78 (95% confidence interval: 0.76-0.80), with gastric premalignant conditions 0.79 (0.77-0.81), previously treated for gastric cancer 0.77 (0.73-0.81) and with present cancer 0.68 (0.55-0.81). Self-reported QoL according to the visual analogue scale (VAS) for the same groups were 0.67 (0.66-0.69), 0.67 (0.66-0.69), 0.62 (0.59-0.65) and 0.62 (0.54-0.70) respectively. Utilities were consistently lower in women versus men (no lesions 0.71 vs. 0.78; premalignant conditions 0.70 vs. 0.82; treated for cancer 0.72 vs. 0.78 and present cancer 0.66 vs. 0.70). The health-related QoL utilities of patients with premalignant conditions are similar to those without gastric diseases whereas patients with present cancer show decreased utilities. Moreover, women had consistently lower utilities than men. These results confirm that the use of a single standardized instrument such as the EQ-5D-5L for all stages of the gastric carcinogenesis cascade is feasible and that it captures differences between conditions and gender dissimilarities, being relevant information for authors pretending to conduct further cost-utility analysis.
    Journal of gastrointestinal and liver diseases: JGLD 12/2014; 23(4):371-8. · 1.85 Impact Factor
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    ABSTRACT: The European Society of Gastrointestinal Endoscopy (ESGE) is dedicated to improving the quality of gastrointestinal endoscopy through educational activities such as live endoscopy events (LEEs). The primary utility of LEEs is the educational value for the audience, and patients should not expect additional benefit from being treated during a LEE compared to a routine setting. Although there is no evidence that LEEs entail additional risks for patients, neither can possible unknown risks be excluded as the evidence available is limited. Therefore, necessary measures should be taken to assure patient safety. Patients must be adequately informed that the standard of care will be assured and that their identity will not be revealed. ESGE recommends that an endoscopist not belonging to the hosting unit is named as patient advocate. Clinical indications for the LEE procedures and the educational outputs must be clear and agreed between host and demonstrator teams. ESGE will ensure that in all ESGE-organized LEEs the indications, procedural descriptions, and adverse events will be registered, and that organizers requesting ESGE endorsement can demonstrate such a registry.
    Endoscopy 10/2014; 47(1). DOI:10.1055/s-0034-1390705 · 5.20 Impact Factor
  • Matilde Monteiro-Soares, Dinis-Ribeiro M
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    ABSTRACT: Understanding the quality of diabetic foot care delivery is essential. The Eurodiale consortium addressed subjects’ characteristics, diabetic foot ulcer prognostic predictors and clinical outcomes, in 10 European countries. We analyzed the results of a specialized Portuguese diabetic foot clinic at the light of the ones from Eurodiale.
    Diabetes Research and Clinical Practice 10/2014; 106(3). DOI:10.1016/j.diabres.2014.09.030 · 2.54 Impact Factor
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    ABSTRACT: We aimed to systematically review the available systems used to classify diabetic foot ulcers (DFU) in order to synthetize their methodological qualitative issues and accuracy to predict lower extremity amputation (LEA), as this may represent a critical point in these patients' care. Two investigators searched, in EBSCO, ISI, PubMed and SCOPUS databases, and independently selected studies published until May 2013 and reporting prognostic accuracy and/or reliability of specific systems for patients with DFU in order to predict LEA. We included 25 studies reporting a prevalence of LEA between 6 to 78%. Eight different DFU descriptions and 7 prognostic stratification classification systems were addressed with a variable (1-9) number of factors included, being the presence of peripheral arterial disease (n = 12) or infection at the ulcer site (n = 10) or its (ulcer) depth (n = 10) the most frequently included. The Meggit-Wagner, S(AD)SAD and Texas University Classification systems were the most extensively validated, whereas 10 classifications were derived or validated only once. Reliability was reported in a single study and accuracy measures reported in 5 studies with another 8 allowing their calculation. Meta-analysis was only possible for the composing variables` accuracy. Pooled accuracy ranged from 0.65 (for gangrene) to 0.74 (for infection). There are numerous classification systems for DFU outcome prediction but only few studies evaluated their reliability or external validity. Also only rarely studies validated several systems' simultaneously and reported accuracy measures. Further studies assessing reliability and accuracy of the available systems and their composing variables are needed. This article is protected by copyright. All rights reserved.
    Diabetes/Metabolism Research and Reviews 10/2014; 30(7). DOI:10.1002/dmrr.2535 · 3.59 Impact Factor
  • Miguel Areia, Mário Dinis-Ribeiro, Francisco Rocha Gonçalves
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    ABSTRACT: Progression of extensive gastric premalignant conditions to cancer might warrant surveillance programms. Recent guidelines suggest a 3-yearly endoscopic follow-up for these patients. Our aim was to determine the cost utility of endoscopic surveillance of patients with extensive gastric premalignant conditions such as extensive atrophy or intestinal metaplasia.
    Helicobacter 08/2014; 19(6). DOI:10.1111/hel.12150 · 2.99 Impact Factor
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    ABSTRACT: Local descriptors coupled with robust methods for learning visual dictionaries have been a pivotal tool in computer vision. Although the identification of similar patterns is commonly conducted on some stage of the bag-of-words framework, a prior assessment of spatial local similarities can be indicative of specific objects, and thus improved recognition rates. In this work we delve a function of similarity for enhancing the discriminative power of local constrained SIFT descriptors. Motivated by gastrointestinal images where diagnosis through endoscopy plays a decisive role in cancer detection and resulting prognosis, visual cues in these early stages are slim and of difficult perception. In order to capture these patterns we propose a self-similarity approach (based on a neighbourhood analysis of SIFT descriptors) to assess local variances through a weight function. Based on extensive simulations our approach achieved a performance of 88%: 3% higher than the standard SIFT, 10% higher than Haar wavelet and 13% higher than LBPs.

Publication Stats

1k Citations
547.26 Total Impact Points


  • 2009–2015
    • University of Porto
      • • Center for Research in Health Technologies and Information Systems
      • • Faculty of Medicine
      Oporto, Porto, Portugal
  • 2002–2015
    • Instituto Português de Oncologia
      • • Department of Pathology
      • • Molecular Oncology Group
      Oporto, Porto, Portugal
    • Hospital de São João
      Oporto, Porto, Portugal
  • 2014
    • American Society for Gastrointestinal Endoscopy
      Society Hill, New Jersey, United States
  • 2012–2014
    • Centre for Research in Health Technologies and Information Systems (CINTESIS)
      Oporto, Porto, Portugal
    • Centro Hospitalar de Vila Nova de Gaia/Espinho
      Portus Cale, Porto, Portugal
  • 2010–2012
    • Centro Hospitalar do Porto
      Oporto, Porto, Portugal
  • 2006–2012
    • Porto Military Hospital
      Oporto, Porto, Portugal
  • 2004
    • Showa University
      Shinagawa, Tōkyō, Japan