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ObjectiveTo develop evidence-based guidance for topical steroid use in paediatric eosinophilic oesophagitis (pEoE) in the UK for both induction and maintenance treatment.MethodsA systematic literature review using Cochrane guidance was carried out by the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) Eosinophilic Oesophagitis (EoE) Working Group (WG) and research leads to determine the evidence base for preparation, dosing and duration of use of swallowed topical steroid (STS) formulations in EoE. Seven themes relating to pEoE were reviewed by the WG, alongside the Cochrane review this formed the evidence base for consensus recommendations for pEoE in the UK. We provide an overview of practical considerations including treatment regimen and dosing. Oral viscous budesonide (OVB) and, if agreed by local regulatory committees, orodispersible budesonide (budesonide 1 mg tablets) were selected for ease of use and with most improvement in histology. A practical ‘how to prepare and use’ OVB appendix is included. Side effects identified included candidiasis and adrenal gland suppression. The use of oral systemic steroids in strictures is discussed briefly.Results2638 citations were identified and 18 randomised controlled trials were included. Evidence exists for the use of STS for induction and maintenance therapy in EoE, especially regarding histological improvement. Using the Appraisal of Guidelines, Research and Evaluation criteria, dosing of steroids by age (0.5 mg two times per day <10 years and 1 mg two times per day ≥10 years) for induction of at least 3 months was suggested based on evidence and practical consideration. Once histological remission is achieved, maintenance dosing of steroids appears to reduce the frequency and severity of relapse, as such a maintenance weaning regimen is proposed.ConclusionA practical, evidence-based flow chart and guidance recommendations with consensus from the EoE WG and education and research representatives of BSPGHAN were developed with detailed practical considerations for use in the UK.

BackgroundEosinophilic oesophagitis (EoE) is an increasingly common cause of dysphagia in both children and adults, as well as one of the most prevalent oesophageal diseases with a significant impact on physical health and quality of life. We have provided a single comprehensive guideline for both paediatric and adult gastroenterologists on current best practice for the evaluation and management of EoE.MethodsThe Oesophageal Section of the British Society of Gastroenterology was commissioned by the Clinical Standards Service Committee to develop these guidelines. The Guideline Development Group included adult and paediatric gastroenterologists, surgeons, dietitians, allergists, pathologists and patient representatives. The Population, Intervention, Comparator and Outcomes process was used to generate questions for a systematic review of the evidence. Published evidence was reviewed and updated to June 2021. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the evidence and make recommendations. Two rounds of voting were held to assess the level of agreement and the strength of recommendations, with 80% consensus required for acceptance.ResultsFifty-seven statements on EoE presentation, diagnosis, investigation, management and complications were produced with further statements created on areas for future research.ConclusionsThese comprehensive adult and paediatric guidelines of the British Society of Gastroenterology and British Society of Paediatric Gastroenterology, Hepatology and Nutrition are based on evidence and expert consensus from a multidisciplinary group of healthcare professionals, including patient advocates and patient support groups, to help clinicians with the management patients with EoE and its complications.

IntroductionPatient Public Involvement (PPI) can enhance research impact; however, it is often poorly described, with a focus on study development. Here we describe an additional utility of PPI in interim qualitative analysis during the recruitment phase of SWALLeOeW, an NIHR supported study investigating the use and acceptability of oesophageal physiology investigations in Eosinophilic Oesophagitis (EoE) and the impact of treatment on oesophageal function.MethodsThe SWALLeOeW advisory group consists of three people with EoE, the Founder of the EOS Network and a patient with experience of oesophageal physiology tests. PPI members are reimbursed for time, travel and subsidence based on INVOLVE principles.Using Braun and Clarke’s1 reflexive thematic analysis and drawing on Stocker et al.’s (2021)2 work on collaborative data analysis, a workshop was held to analyse data collected to completion to date (n=5). The advisory group read Coding Reports (transcripts of all conversations) on topics including ‘Acceptability’ and ‘Diet & Food’ in advance. Mind maps were created to extract meaningful, coherent content.ResultsThe SWALLeOeW advisory group has contributed to study conceptualisation, development of data collection materials and, as described here, interim interview analysis. When interpreting accounts of participant interviews the group summarised the following key ideas:Participants find physiology investigations challenging, but are motivated to continue in the study and repeat investigations post–treatment in order to better understand their condition ‘Anything to get further information’. This drive to seek information was felt to be linked to a degree of suspicion and doubt surrounding their EoE diagnosis and the group felt there was a recurring narrative of ‘is the support going to last’. Socially minded altruism also drove participation: ‘I felt good to be assisting the research in something that is not very well known’.Participants are often ‘well people’ and display a desire for health autonomy. Difficulty navigating dietary restrictions can challenge this autonomy: ‘So, you know, is it all wheat? Is it gluten? Is gluten wheat?’.Participants indicated that study participation improves access to care. The advisory group also provided a perspective that the study provides a point of contact and emotional support for those with a new diagnosis.ConclusionsWe demonstrate that PPI is practicable in both design and early analysis of SWALLeOeW study data. Involving PPI members as citizen scientists provided new perspectives, enriching analysis of transcripts. This interim analysis will contribute to the development of final themes in the SWALLeOeW Study with suggestion that diagnostic clarity and support will be pertinent to this ongoing work.ReferencesBraun, Clarke. APA. 2012;55-71.Stocker, et al. Health Expect. 2021;24(4):1349–1356.

Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated oesophageal disease requiring surveillance and treatment for most patients1 and an increasing prevalence of around 1 in 3000 in the UK.2 3 It has significant impact on physical and mental health and quality of life. Formal transition of care from paediatric to adult services may improve symptom control, concordance with therapy and reduce emergency presentations.4 Therefore the BSPGHAN EOE Working group evaluated current arrangements for transition of patients with EoE.The BSPGHAN EoE WG held number of professional consultations and developed an EoE Transition survey questionnaire for professionals, patients and parents. The transition survey was circulated electronically via BSPGHAN newsletter, EOS network, GutsUK Charity website and WhatsApp to BSPGHAN/PeGHAN members.The survey period ranged from October to Nov 2023 and received 29 health professionals response.Majority response were received from Paediatric Gastroenterologists (15/29) followed by Paediatricians with special interest in Gastroenterology/allergy (11/29) and working in tertiary care (18/29) followed by secondary care (11/29) from all across the UK.We identified variation between units in terms of professionals/teams looking after children with EOE (figure 1).Most of the professionals transfer care by referral to adult gastroenterologists (60%) followed by GPs (16%) and most of referrals were paper referrals (73%) followed by face 2 face in MDT setting or paediatric to adult referral pathway (12% each)It seems typically transition/discharge of patient to adult services occur at 16yrs (17/29) followed by 17yrs (8/29), and 18 yrs (4/29).A formal transition process is reported in only 27% (8/29) of units with no such process in 73% (21/29) units.Among 8 units with established transition clinics, 5 units reports >50% attendance, and 3 units report <25% attendance.Out of 21 units with no formal transition process, 14 units consider the need.Overall professionals identified following barriers for successful implementation of a transition process: Lack of guidance/guidelines on transition (27%), lack of resources (23%), lack of a transition clinic (20%), lack of adult gastroenterology service with EoE interest (20%), lack of adult dietitian (10%).This transition survey captures view from all across the UK which represents the first nationwide EoE transition survey in the UK. The majority of EOE patients are discharged to adult gastroenterologist by means of traditional paper referral letter. Most of the units transition at the age of 16 years to 17 years. However national recommendation is for the transition process to start around 13–14 years of age.5 There is lack of a formal transition process in 70% of the units. In places where transition services are available there is good engagement as evidenced by high attendance. Main barriers for establishment of transition process is a lack of guidance/guidelines. The EoE working group is in the process of collecting responses from carers and patients and will develop evidence based guidance to patients and professionals.Abstract OC11 Figure 1Paediatric team that cares for EoE patients in the regionReferencesMuir A, Walk G, Eosinophic esophagitis: a review. JAMA 2021; Oct 5;326(13):1310–1318.Dellon ES, Epidemiology and natural history of eosinophilic esophagitis. Gastroenterology. 2018 January;154(2)Gutscharity. org.uk/advice-and-information/conditions/eosinophilic-diseasesDhar A, Haboubi HN, Attwood SE, et al. British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults. Gut 2022;71:1459–1487.Nice Guideline (NG43): Transition from children’s to adults services for young people using health or social care services.

The BSPGHAN eosinophilic oesophagitis working group (EoE-WG) was established in 2020, and identified heterogeneity in the management of paediatric EoE. BSG/BSPGHAN consensus guidelines for EoE in children and adults were published in 2022.1 This baseline survey was conducted between March 2021 and December 2022 by the EoE-WG, with 45 respondents from 33 paediatric centres in the UK and Ireland. The survey explored clinical presentation, diagnostic approaches, treatment modalities, monitoring and service setups used by clinicians managing this condition.Dysphagia and bolus impaction emerged as prominent symptoms, with around a third of respondents highlighting increased liquid intake during meals and slow eating/prolonged chewing as important behaviours. In children with limited language, distress during feeding, food aversion, vomiting/regurgitation, and weight loss/failure to thrive were prevalent. The majority of patients were diagnosed within a year of symptom onset, although children at some centres took up to five years. The median age at diagnosis was 10 years. Common comorbidities include asthma, eczema, and allergies, aligning with expectations. Surprisingly, whereas three-quarters of patients had asthma as a comorbidity, only a quarter of clinicians identified it as a risk factor for EoE. Tracheo-oesophageal fistula exhibited a relatively high co-existence, prompting consideration for further prevalence data collection.Oesophagogastroduodenoscopy (OGD) was performed by 93% of responding clinicians. While duodenal biopsies were universally taken, the approach to oesophageal biopsies differed among clinicians, with most taking six biopsies from three oesophageal levels. The number of biopsies varied based on disease probability and practical considerations. Some centres found that two biopsies at each level showed good agreement on EoE features.A majority of clinicians use histology for description of disease activity (71%), with endoscopic appearance being equally used to grade EoE severity (73%). Contrast swallows were commonly requested in cases of dysphagia or suspected mechanical obstruction, while impedance measurement was used in reflux-related symptoms. Few clinicians opted for additional tests.Disease severity, protocols, and patient preference were the primary factors influencing the selection of first-line treatment. PPIs were the preferred medical therapy across all age groups (91%). Topical steroids were used as second most common treatment (69%, increasing to 82% as second-line treatment). Exclusion diets were more used by 62% of clinicians (more commonly in younger children). Approximately 36% of clinicians had not encountered stricturing disease. Dilatation (often in consultation with surgeons or radiologists) was favoured as first-line treatment for strictures, followed by topical steroids. PPIs and exclusion diets were less commonly chosen.Most clinicians reviewed treatment at three months, relying on clinician-initiated symptom reviews and histology. Most clinicians (93%) did not use EoE quality of life scoring systems. The majority of clinicians expressed a preference for re-scoping (73% with, versus 87% without clinical improvement, although they also highlighted limited endoscopy capacity.This survey provides valuable insights into the current practices in the management of EoE, highlighting variations in diagnostic and treatment approaches. The findings underscore the need for education, training, funded research and standardisation in the management of this chronic condition.ReferencesDhar A, Haboubi HN, Attwood SE, et al. British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults. Gut. 2022; doi:10.1136/gutjnl-2022–327326