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Eosinophilic oesophagitis (EOE) is an antigen mediated inflammatory disorder of the oesophagus; defined by symptoms of oesophageal dysfunction and histological findings of eosinophil infiltration with an eosinophil count of more than 15 per high power field. 1 Management strategies include dietary eliminations, proton pump inhibitor (PPI) therapy and topical steroids. Oral viscous budesonide (OVB) is most commonly used but has limitations in difficulty of making up the slurry, difficulty obtaining the sweetener used to mix the solution, and parental concern about use of artificial sweetener.2 Jorveza (orodispersible budesonide) is an alternative preparation but is only licensed in over 18 years.2 The aim of this study was to evaluate management strategies in patients with EOE in a single tertiary paediatric centre. Specifically looking to compare the use of Jorveza in the paediatric cohort compared with more traditional treatment strategies (PPI, dietary exclusion, OVB or combination therapy). The hypothesis was that better clinical and histological remission rates would be seen in the Jorveza cohort.A retrospective review of patient records identified 45 patients diagnosed with EOE between 2012 and 2024 (41 male, 4 female) with age ranging from 2 to 16 years at presentation. Data was collected on symptoms at presentation, histological findings, therapeutic management and clinical remission status.13 patients were treated with monotherapy (either PPI, Jorveza, OVB or dietary exclusion) and 32 received combination therapy (any combination of the above). 9 patients in total were treated with dietary exclusion- 1 with exclusion alone; 8 with combination medical and dietary therapy. 1 patient had a six food elimination diet and 8 eliminated 1–2 food groups, most commonly dairy. Of the 9 patients who received Jorveza/PPI 6 (85%) were in clinical remission (the remaining patient had not yet been reassessed). The 2 patients receiving Jorveza monotherapy are awaiting reassessment. 13/17 (76%) patients who received OVB/PPI were in clinical remission. 2/4 (50%) patients who were treated with PPI/OVB/dietary exclusion were in clinical remission.The numbers remain small; but this study reflects slightly improved clinical remission rates in patients using Jorveza. This may be explained by ease of administration, better tolerance and therefore improved compliance compared to OVB in paediatric patients. This study also highlights the inconsistent implementation of elimination diets based on patient reported symptoms and specific IgE allergy testing. Ease of access to endoscopy is imperative in making clear decisions about elimination strategies. Close working with the dietetic department to formulate a pathway for dietary exclusions is vital. With a multitude of potential therapeutic combinations available, a stepwise approach catered for the patient and their family should always be utilised.1 3 Jorveza seems to be a promising option for patients with EOE but more data needs to be collected on both clinical and histological outcome.References Amil-Dias J, Oliva S, Papadopoulou A, et al. Diagnosis and management of eosinophilic esophagitis in children: an update from the European society for paediatric gastroenterology, hepatology and nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2024 Aug;79(2):394–437.Spennacchio A, Lopalco A, Racaniello GF, et al. Mucoadhesive budesonide solution for the treatment of pediatric eosinophilic esophagitis. Pharmaceuticals (Basel) 2024 Apr 24;17(5):550. doi: 10.3390/ph17050550. PMID: 38794121; PMCID: PMC11124118.Barni S, Arasi S, Mastrorilli C, Pecoraro L, et al. Pediatric eosinophilic esophagitis: a review for the clinician. Ital J Pediatr. 2021 Nov 22;47(1):230.