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Eosinophilic esophagitis(EOE), a chronic inflammatory condition, has become a leading cause of children presenting with dysphagia. British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines from 2022 suggests Topical steroids are effective for inducing histological and clinical remission in eosinophilic oesophagitis. 1We conducted a retrospective review of Histology samples sent for assessment of EOE, and correlated it with Clinic letters, patient records, endoscopy findings both macroscopic and microscopic evidence to evaluate the different treatment modalities offered and the effectiveness of orodispersible budesonide(Jorveza) in comparison to conventional therapies as dietary restriction and proton pump inhibitors.The demographic data suggests a mean age of 11 years, median age of 11.5 years with a male to female ratio of 2:1. Between January 2023 and January 2025 a total of 44 Endoscopy assessments were carried out with indications being either suspected EOE (n=25) or reassessment for EOE(n=19). 16 out of the 25 had a histological confirmation of EOE.A total of 35 EOE cases identified, 28 of these children were treated with orodispersible budesonide (Jorveza) as first line with 21 cases of combined treatment with PPI. In 7 cases Jorveza alone was given, and 4 children had Exclusion dietOur findings suggest that, Both the Jorveza only (100%) and the Jorveza +PPI Combination group(85%) had a higher clinical response rate in comparison to the exclusion diet alone with Clinical resolution of 75%. The PPI only group had a poor response rate of 33% in comparison to the groups, but only 3 children were on isolated PPIs in our cohort.85% of children (30/35) were able to successfully complete Jorveza course, the common causes for inability to complete were identified as either taste of the medication or unable to follow instructions as children with special educational needs.The Endoscopic responses of the children post induction treatment was difficult to interpret as many(14/35) have not had a repeat endoscopy post treatment and were subjected to further maintenance treatment or switch in the treatment based on clinical symptoms alone. Clinical resolution of symptoms has not translated well into endoscopic resolution of symptoms. 82%(29/35) have reported symptoms resolution while endoscopic resolution was only evidenced in about 38%(8/21). We have also found that endoscopic assessment performed while on Jorveza demonstrated a higher resolution (60%) in compared with children who were off Jorveza treatment(50%).These findings highlights the importance of endoscopic evaluation as a guide for EOE surveillance and to guide further treatment pathways.Reference Dhar A, Haboubi HN, Attwood SE, et al. Gut 2022;71:1459–1487.Abstract OC60 Table 1Key Summary of findingsTreatment groupTotalClinical responseEndoscopic responsePPI only3⅓ = 33%0/1 = 0%Jorveza77/7 = 100%⅔ = 66%Jorveza + PPI2118/21 = 85%5/13 = 38%Exclusion diet4¾ = 75%¼ = 25%