Literature Collection

CONTEXT: Exploratory buprenorphine ingestions in young children have been associated with clinically significant toxicity. However, detailed data on the clinical presentation and management of these patients are lacking. In an attempt to obtain more comprehensive data, we sought to examine a single center cohort of patients with report of buprenorphine exposure and provide descriptive analysis of rates of respiratory depression, time to respiratory depression, interventions, disposition, and outcomes. STUDY DESIGN: We performed a retrospective cohort study at a single pediatric tertiary care center of children between the age of 6 months and 7 years of age hospitalized between 1 January 2006 and 1 September 2014 with report of buprenorphine or buprenorphine/naloxone exposure. Patients with possible exposure to more than one agent were excluded. We extracted clinical findings, including time to respiratory depression, interventions, and disposition from the medical record. RESULTS: Eighty-eight patients met the inclusion criteria. Seven patients were excluded. The median age was 24 months [IQR 18-30]. 20 patients (23%) received activated charcoal while 48 (55%) were treated with naloxone. 36 (41%) patients were admitted to the ICU. Observed clinical effects included respiratory depression (83%), oxygen saturation by pulse oximetry (SpO2) < 93% (28%), depressed mental status (80%), miosis (77%), and emesis (45%). Median time from exposure to respiratory depression was 263 min [IQR 105-486]. The median hospital length of stay was 22 h [IQR 20-26] and was positively associated with estimated exposure dose (p = 0.002). CONCLUSION: Pediatric patients exposed to buprenorphine are likely to exhibit signs and symptoms of opioid toxicity, including respiratory depression, altered mental status and miosis. Although the majority of patients developed signs of clinical toxicity within 8 h of reported exposure, the optimum duration of monitoring remains unclear.

BACKGROUND: Patients with disorders of gut-brain interaction (DGBIs) presenting to specialist care have a high prevalence of psychiatric morbidity. Psychiatrists can provide effective treatments for these disorders; however, care is rarely delivered in an integrated manner. AIMS: This study aimed to characterise patients seen by psychiatrists in a multidisciplinary gastrointestinal (GI) clinic, describe the treatment provided and examine clinical outcomes. METHODS: In a single-centre multidisciplinary gastroenterology clinic, clinical records were retrospectively evaluated for patients with DGBIs seen by a psychiatrist. Patient demographics, medical and psychiatric history, records of adverse childhood experiences (ACEs) and adult trauma were collected. GI and mental health symptom outcomes were assessed using a five-point scale. RESULTS: Ninety-seven patients (median age, 35 years; 77% female) were seen by the psychiatrist (median treatment duration 2.5 months) between January 2017 and November 2021. Fifty-six per cent had irritable bowel syndrome and 18% had functional dyspepsia. Common psychiatric comorbidities were anxiety (51%) and depression (43%). Seventy-seven per cent had a history of ACEs and 26% had a history of sexual trauma. Seventy-five per cent had previously seen a psychiatrist or psychologist. DGBI-Clinic psychiatrists provided a range of treatments including psychoeducation (64%), insight-oriented psychotherapy (39%), medication changes (27%) and cognitive behavioural therapy (19%). A majority of patients had improvement (46%) or resolution (11%) in GI symptoms. Forty per cent experienced improvement in mental health symptoms. Improvement in GI and mental health symptoms were correlated (P = 0.002). CONCLUSIONS: A majority of patients with DGBI who were seen by psychiatrists within a multidisciplinary clinic demonstrated improvement in GI and mental health symptoms.