Jorge Fonseca

Hospital Garcia de Orta | hgarciaorta · Gastroenterology

Most hospitalized COVID-19 pneumonia patients are older adults and/or have nutrition-related issues. Many are bedridden in intensive care units (ICU), a well-documented cause of malnutrition, muscle wasting, and functional impairment. Objectives: To assess the effectiveness of an intensive rehabilitation program over the nutritional/functional stat...

Background: Endoscopic Gastrostomy (PEG) is required to maintain a feeding route when neurological or cancer dysphagia impact oral intake. This study aimed to evaluate the oral health and oral changes of PEG-patients without oral feeding for three months. Methods: Prospective observational study, with a PEG-patients convenience sample. Data were...

Introduction: Anastomotic leak (AL) is a dangerous complication in the early postoperative period after total gastrectomy or esophagectomy being associated with high mortality. Self-expandable metal stents (SEMS) play a significant role in AL management. Only one case report described the use of Mega-Stent in AL setting. The authors report a two-ca...

b> Introduction: Home parenteral nutrition (HPN) and/or home parenteral hydration (HPH) are the gold-standard treatment for patients with long-term intestinal failure (IF). The authors aimed to assess the impact of HPN/HPH on nutritional status and survival of long-term IF patients, as well as HPN/HPH-related complications. Methods: This was a retr...

Ageism refers to stereotyping (how we think), prejudice (how we feel), and discrimination (how we act) against people based on their age. It is a serious public health issue that can negatively impact older people’s health and quality of life. The present protocol has several goals: (1) adapt the Ambivalent Ageism Scale for the general Portuguese p...

Reports of obstructing foreign bodies in the small bowel are rare and the majority describe surgical resolution. We report a case of successful endoscopic treatment of small bowel obstruction (SBO) caused by multiple bezoars. A 92-year-old woman presented to the emergency department with a history of persistent vomiting. Computed tomography (CT) sh...

Nutrition is an important health issue for seniors. In nursing homes, simple, inexpensive, fast, and validated tools to assess nutritional risk/status are indispensable. A multisurvey cross-sectional study with a convenient sample was created, comparing five nutritional screening/assessment tools and the time required for each, in order to identify...

Background: Acute lower gastrointestinal bleeding is a common cause of hospital admission. NOBLADS is a lower gastrointestinal bleeding clinical risk score. Objective: This study aimed to externally validate NOBLADS in predicting severe acute lower gastrointestinal bleeding and clinical outcome. Design: Observational retrospective study. Sett...

Introduction: 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 observation...

Upper gastrointestinal bleeding (UGIB) is a common cause of hospital admission and variceal hemorrhage is responsible for many UGIB cases. Esophageal and gastric varices are caused by portal hypertension (PHT), mostly due to liver cirrhosis. Portal vein thrombosis (PVT) is an important cause of non-cirrhotic PHT and can be associated with several d...

Intestinal failure is the reduction in gut function below the minimum necessary for the absorption of macronutrients and/or water electrolytes. The based treatment for type II and III intestinal failure patients is home parenteral nutrition (HPN) and hydration (HPH). This is a case-series study of HPN/HPH patients of the Hospital Garcia de Orta, Po...

The hallmark of Parkinson’s disease (PD) is the accumulation of alpha-synuclein (AS) aggregates. Prior to the central nervous system involvement, PD establishes itself in the gut as a result of the complex interplay between microbiota, the host’s immune/neural systems and increased intestinal permeability. Inflammatory Bowel Disease (IBD) patients...

A growing body of evidence suggests that nutritional status may play an important role in the development and course of Parkinson’s disease (PD). Nutritional status is known to influence PD motor and non-motor features and is in turn influenced by disease duration and severity. A proper nutritional status assessment and intervention should be incor...

The neuropathological hallmark of Parkinson’s disease (PD) is the accumulation of alpha–synuclein (AS) aggregates. The identification of AS aggregates in gut biopsy specimens from people with PD may provide an opportunity to identify PD at a very early stage, prior to symptom onset. Changes in gut microbiota and inflammatory conditions (such as per...

Nutrition status is a major issue of the COVID-19 pandemic. Many factors associated with worse prognosis risk are related to nutrition. Patients received after hospital discharge for pneumonia due to SARS-Cov-2 were submitted to a multidisciplinary rehabilitation program. This study aimed to analyze the nutritional and functional status after SARS-...

Introduction: Since the rise of the COVID-19 pandemic there has been widespread concern regarding the possible delay in the diagnosis/treatment of cancer patients. We aimed to assess the impact of the COVID-19 pandemic on the diagnosis, treatment, and outcome of patients with digestive cancer. Methods: This was a retrospective study including pa...

Objective Vitamin D plays a major role in biological processes. Its deficiency is associated with increased morbidity and mortality. Patients who have undergone endoscopic gastrostomy (PEG) present with protein-energy malnutrition, and may be at risk for Vitamin D deficiency, due to their age, less sunlight exposure and lower dietary intake. We aim...

Introduction and aims: Patients undergoing percutaneous endoscopic gastrostomy (PEG) may present protein-energy malnutrition, anemia and deficiencies of hematopoietic factors, e.g., iron, folate and vitamin B12. There are no comprehensive studies on anemia or other hematological changes in PEG-patients. Our aim was to evaluate the hematological st...

Objective Vitamin D plays a major role in biological processes. Its deficiency is associated with increased morbidity and mortality. Patients who have undergone endoscopic gastrostomy (PEG) present with protein-energy malnutrition, and may be at risk for Vitamin D deficiency, due to their age, less sunlight exposure and lower dietary intake. We aim...

Introduction: Dieulafoy's lesion (DL) is a rare but important cause of acute, severe, life-threatening, and recurrent upper gastrointestinal bleeding (UGIB). It is frequently difficult to diagnose DL with upper GI endoscopy (UGIE), and endoscopic ultrasonography (EUS) may be valuable. There are only 2 reported bleeding cases caused by two synchron...

Background and aims: esophageal cancer (EC) is an important health problem worldwide with high morbidity and mortality. EC patients are likely to develop malnutrition. The aim of this study was to assess the feasibility and safety of endoscopic gastrostomy (PEG) feeding in EC cancer, and to identify risk factors associated with poor prognosis. Me...

Background: Digestive tumours are among the leading causes of morbidity and mortality. Many cancer patients cannot maintain oral feeding and develop malnutrition. The authors aim to: review the endoscopic, radiologic and surgical techniques for nutritional support in cancer patients; address the strategies for nutritional intervention according to...

Background: High prevalence of dental caries in ulcerative colitis (UC) has been attributed to diet and changes in salivary environment. Objective: We aimed to characterize the prevalence of dental caries, salivary flow rates, salivary buffering capacity and cariogenic bacteria counts of Mutans streptococci and Lactobacillus spp and to evaluate...

The authors describe a 31 years old male, admitted for hematemesis, epigastric pain and lower limb edema. Laboratorial data showed haemoglobin 18.4g/dl, total proteins 2.8g/dl, albumin 1.6g/dl and hipogammaglobulinaemia. 24h urinary proteins were normal. HIV and CMV serology were negative. Upper GI endoscopy revealed markedly enlarged gastric folds...

Aníbal Marinho 1 (https://orcid.org/0000-0002-9160-8649), Ana Lopes 2 (https://orcid.org/0000-0002-9160-8649), Gabriela Sousa 3 (https://orcid.org/0000-0002-1563-5522), Henedina Antunes 4 (https://orcid.org/0000-0002-1035-0173), Jorge Fon-seca 5 (https://orcid.org/0000-0001-6477-7028), Lino Mendes 6 (https://orcid.org/0000-0002-7237-6272), Mamede d...

Percutaneous endoscopic gastrostomy (PEG) is a safe technique for long-term enteral feeding. The most common PEG-associated adverse events are minor. Gastrocolocutaneous fistula (GCCF) results from misplacement of the PEG tube through the colon. The importance of this complication is not currently defined, and there is no clearly established therap...

Introduction: Endoscopic gastrostomy (PEG) is the gold standard for long-term enteral feeding for patients who lose the ability to swallow, which deprives the passage of food and liquids through the mouth. Normal oral microbiota is known to perform functions of protection and maintenance of oral and systemic health. Therefore, oral dysbiosis, promo...

Background: Hepatic glycogenosis (HG) is a complication of poorly controlled type 1 diabetes mellitus (T1DM), characterized by glycogen accumulation in hepatocytes. Mauriac syndrome (MS) is a glycogenic hepatopathy, initially described in 1930, characterized by growth failure, delayed puberty, cushingoid appearance, hepatomegaly with abnormal live...

before endoscopic gastrostomy predicts higher mortality during the first week and first month post-gastrostomy: a risk marker of refeeding syndrome in gastrostomy-fed patients. Resumen Introducción: la inanición es habitual en pacientes referenciados para gastrostomía endoscópica (PEG). Un riesgo alto de síndrome de reali-mentación (SR) puede contr...

Background & aims: Malnutrition is common in patients eligible for percutaneous endoscopic gastrostomy (PEG). Feeding tube transparietal thickness (TT) may contribute to assess nutritional status. This study aims to: 1) Characterize TT in PEG patients. 2) Determine the association between TT and the currently used tools 3) Define TT best cut-offs...

Introduction: starvation is usual in patients referred for endoscopic gastrostomy (PEG). A high risk of refeeding syndrome (RS) may contribute to poor prognosis. Objectives: this study aims to: a) evaluate serum phosphorus and magnesium when patients underwent PEG; b) determine the mortality rate during the first week and first month of enteral...

Background and aims: Hemorrhoid disorders are common. This study aimed to assess the efficacy and safety of polidocanol foam injected at high doses with intravenous needle for the treatment of symptomatic internal hemorrhoids that prolapse or bleed. Methods: We evaluated 2,000 consecutive patients with prolapsed hemorrhoids (grades II/III/IV) re...

Clinical nutrition is emerging as a major area in gastroenterology practice. Most gastrointestinal disorders interfere with digestive physiology and compromise nutritional status. Refeeding syndrome (RS) may increase morbidity and mortality in gastroenterology patients. Literature search using the keywords "Refeeding Syndrome", "Hypophosphatemia",...

Background: Percutaneous endoscopic gastrostomy (PEG) is a gold standard for long term enteral feeding. Neurologic dysphagia and head/neck cancer are the most common indications for PEG as they can lead to protein-energy malnutrition and serum electrolyte abnormalities, with potential negative impact on metabolic balance. Refeeding syndrome may al...

The authors describe a 47-year-old man infected with human immunodeficiency virus admitted for ascites and weight loss. Ascitic fluid analysis revealed chylous ascites (triglycerides 444 mg/dl) with negative microbiological tests. Neoplasia, cardiac disease and liver cirrhosis were excluded after an extensive diagnostic workout. Exploratory laparot...

Background Previous reports demonstrated a higher prevalence of dental caries in patients with ulcerative colitis (UC). The risk has been attributed to diet and changes in salivary environment. We aimed to characterise the prevalence of dental caries, salivary flow rates, salivary buffering capacity and cariogenic bacteria counts of Mutans streptoc...

Background and aims: Bowel preparation for colonoscopy induces a semi-fasting state, with a potential negative impact on fragile patients. The present study aims to quantify nutritional deficiency during colonoscopy preparation. Methods: This was an observational and cross-sectional study. A convenience sample was obtained that included adults t...

The authors describe a 31-year-old man admitted due to progressive weight loss, diarrhea and massive hepatomegaly. Laboratory data showed anemia (haemoglobin 11.7 g/dl), abnormal liver tests (total bilirubin 1.4 g/dl, aspartate aminotransferase 70 U/l, alanine aminotransferase 37 U/l and alkaline phosphatase 520 U/l). Abdominal ultrasound (US) disp...

Background: Endoscopic gastrostomy (PEG) fed patients, including those with neurologic disorders (ND) or head and neck cancer (HNC) present high malnutrition risk and speech difficulties. Teams taking care of these patients need to rely on anthropometric data. Skinfold thickness (TSF) is used to assess nutritional status, but the use of heavy, lar...

SUN-P202 SERUM ELECTROLYTES AND OUTCOME IN PATIENTS UNDERGOING ENDOSCOPIC GASTROSTOMY J. Vieira, G. Nunes, C. A. Santos, J. Fonseca. Artificial Feeding Team, Hospital Garcia de Orta, Almada, Portugal Rationale: Endoscopic Gastrostomy (PEG) is a gold standard for long term enteral feeding. Neurological dysphagia and heador neck cancer are the main i...

SUN-P296 HYPOVITAMINOSIS D IN DYSPHAGIC PATIENTS THAT UNDERWENT ENDOSCOPIC GASTROSTOMY C. Santos, A. Barata, G. Nunes, J. Fonseca. Hospital Garcia de Orta, Almada, Portugal Rationale: Vitamin D deficiency is a major public health problem and increased risk to develop vitamin D deficiency comprise insufficient sunlight and reduced alimentary intake....

SUN-P079 NUTRITIONAL STATUS AND CHEMOTHERAPY-INDUCED NEUTROPENIA A. Barata, C. Santos, G. Nunes, H. Mansinho, J. Fonseca. Hospital Garcia de Orta, Almada, Portugal Rationale: Neutropenia is the most frequent complication associated with myelosuppression induced by chemotherapy drugs. The frequency and severity of neutropenia may reduce the therapeu...

Background & aims: Body Mass Index (BMI) is a simple and widespread method to assess undernutrition. However its use may be limited in bedridden patients. Aims: 1) compare BMI, Mid Upper Arm Circumference (MUAC) and Powell-Tuck and Hennessy's regression equation for BMI (BMIPTH) in gastrostomy fed patients, 2) validate its correlation for sequen...

Background:: Protein-calorie malnutrition is common in chronic liver disease (CLD) but adequate clinical tools for nutritional assessment are not defined. Objective:: In CLD patients, it was aimed: 1. Characterize protein-calorie malnutrition; 2. Compare several clinical, anthropometric and functional tools; 3. Study the association malnutrition...

BACKGROUND Patients that underwent Percutaneous Endoscopic Gastrostomy (PEG) present with protein-energy malnutrition. Trace elements are required in small quantities and Chromium (Cr) displays a major role in the metabolism. OBJECTIVE This study aims to evaluate Cr levels and its relationship with serum proteins, BMI and underlying diseases durin...

Background and aims: Acute-on-chronic liver failure (ACLF) is a frequent syndrome associated with high mortality. The aims of the present study are: a) comparing the Chronic Liver Failure Consortium (CLIF-C) ACLF Model for End-Stage Liver Disease (MELD), MELD Sodium (MELD-Na) and Child-Turcotte-Pugh (CTP) scores for prediction of short/medium term...

A 75-year-old woman was admitted to the Emergency Room with abdominal pain and coffee ground vomiting persisting for three days and presented marked epigastric disten-sion and tenderness. Laboratory analysis revealed dehydration with kidney injury (creatinine 2.8 mg/dl), hypokalaemia (K+ 2.6 mmol/l) and hypernatremia (Na+ 148 mmol/l). Endosco-py sh...

A 75-year-old woman was admitted to the Emergency Room with abdominal pain and coffee ground vomiting persisting for three days and presented marked epigastric disten-sion and tenderness. Laboratory analysis revealed dehydration with kidney injury (creatinine 2.8 mg/dl), hypokalaemia (K+ 2.6 mmol/l) and hypernatremia (Na+ 148 mmol/l). Endosco-py sh...

Background: Percutaneous endoscopic gastrostomy (PEG) is a safe procedure and major morbidity is unusual. However, the number of PEG fed patients is increasing all over the world and complications may become more and more frequent. Case report: We describe a 73 years old woman with persistent vomit after replacement of the standard PEG tube with...

Celiac disease (CD) is a chronic immune-mediated enteropathy driven by gluten and affecting individuals of all ages. The diagnosis of CD in adulthood is emerging and patients often present with nonclassical extraintestinal manifestations. We report the case of a 53-year-old man presenting with neuromuscular symptoms, skin rash, inconspicuous chroni...

Persistent mechanical or functional dysphagia is the most common clinical indication for endoscopic gastrostomy (PEG), however less common conditions may justify prolonged enteral feeding to avoid malnutrition and prevent aspiration. The authors report the case of a 76 year old man referred to the artificial feeding outpatient clinic presenting dys...

Introduction: Undernutrition is frequently associated with advanced lung cancer. Accurate nutritional assessment tools are important to provide the proper nutritional therapy. Handgrip dynamometry has already been used in these patients, and the findings suggest that it is a good indicator of nutritional status. Aims: The aim of this study was t...

Background: Percutaneous endoscopic gastrostomy (PEG) became the gold standard for enteral feeding. Currently, surgical gastrostomy is seldom used. Objective: Evaluating the role of surgical gastrostomy in a center with a large experience in PEG. Methods: A retrospective study ranged 13 years, collecting from clinical records: age, gender, und...

Introduction: Patients who underwent endoscopic gastrostomy (PEG) present protein-energy malnutrition, but little is known about Trace Elements (TE),Zinc (Zn), Copper (Cu), Selenium (Se), Iron (Fe), Chromium (Cr). Aims: Our aim was to evaluate serum protein and TE evolution during the first 3 months after gastrostomy with homemade PEG feeding, and...

Introduction: Patients who underwent endoscopic gastrostomy (PEG) present protein-energy malnutrition, but little is known about Trace Elements (TE), Zinc (Zn), Copper (Cu), Selenium (Se), Iron (Fe), Chromium (Cr). Aims: Our aim was to evaluate serum protein and TE evolution during the first 3 months after gastrostomy with homemade PEG feeding, and...