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Introduction Eosinophilic oesophagitis (EoE) is a chronic immune-mediated inflammatory condition causing dysphagia and food bolus obstruction. Management includes dietary elimination, proton pump inhibitors, swallowed topical corticosteroids and endoscopic dilatation. Orodispersible budesonide (Jorveza®) has demonstrated efficacy in inducing and maintaining clinico-histological remission in randomised controlled trials, including EOS-1 and EOS-2 and their extension phases. Real world data remain limited, particularly for maintenance dosing. This study evaluates outcomes of orodispersible budesonide in adults with EoE in routine clinical practice.Methods We performed a single centre retrospective review of adults treated with orodispersible budesonide for EoE. Data extracted from electronic records included symptoms, peak oesophageal eosinophil counts (eos/hpf) and endoscopic findings before and after induction and maintenance therapy. Sub-analyses examined maintenance dosing regimens and concurrent PPI use.Results 142 patients were included; 69% male, aged 17–74 years. All had histologically confirmed EoE (mean 69 eos/hpf) prior to treatment. 45/142 (32%) were concurrently taking a PPI.Induction therapy with 1 mg twice daily (BD) for 8–12 weeks was prescribed in 139/142 (98%) patients, of whom 96/139 (69%) underwent post-induction OGD. Histological remission (<15 eos/hpf) was achieved in 82/96 (85%).Maintenance therapy was continued in 113/142 (80%) patients: 45/113 (40%) received 0.5 mg BD and 68/113 (60%) received 1 mg once daily (OD). At last review, 86/113 (76%) remained on maintenance, with a mean treatment duration of 20 months. 27/113 (24%) discontinued therapy, most commonly due to adverse effects (8/27, 30%). Overall, 28/142 (20%) experienced adverse effects, most frequently oesophageal candidiasis (21/28, 75%).Repeat biopsies during maintenance therapy were performed in 35/113 (31%) patients (9/35 on 0.5mg BD and 26/35 on 1mg OD); all had achieved remission after induction and 23/35 (66%) remained in histological remission (5/23 0.5mg BD, 18/23 1mg OD). Of the 12/35 (34%) with recurrent eosinophilia, 7/12 (58%) reported intermittent use.Post induction symptom assessment was documented in 78/142 (55%). Among these, 60/78 (77%) had symptom resolution and 15/78 (19%) partial improvement. Partial symptom recurrence on maintenance dosing occurred in 10/60 (17%), 6/10 on 0.5mg BD and 4/10 on 1mg OD.Conclusion Orodispersible budesonide achieved high rates of histological remission following induction therapy. Maintenance therapy was effective in many patients, although loss of response occurred, most commonly with intermittent use. Both once daily and twice daily maintenance regimens appeared effective, supporting the importance of adherence rather than dose selection alone in maintaining remission.