OC17 Oral viscous budesonide (OVB) technique: a patient adherence improvement project

Eosinophilic oesophagitis (EoE) is a rare allergic condition of the oesophagus. Untreated inflammation can lead to oesophageal strictures/dysphagia; impacting quality of life (QOL). There are three recommended treatments’ for EoE; proton pump inhibitors (PPI’s), dietary exclusions or swallowed topical steroids (budesonide and fluticasone). Until recently there has been no commercial budesonide preparation available for use in EoE. Oro-dispersible tablet, Jorveza®, is licenced only in > 18 years of age. In paediatrics, families are provided with viscous budesonide vial and instructed to make into a slurry swallow. OVB should have a standardised consistency to ensure adequate contact time in the oesophagus. Incorrect preparation technique can result in inadequate management, unnecessary treatment escalation/additional endoscopic investigations; potentially reducing QOL. Our multidisciplinary (MDT) clinic established that incorrectly preparing OVB was a frequent problem; suspected to affect compliance and treatment outcomes. The current recommended ratio for budesonide to sucralose sweetener to make OVB is 5g per 0.5 mg/2 ml budesonide vial. The use of other vehicles e.g., apple puree and linctus are less well studied. Our aim was to improve patient adherence and QOL by simplifying OVB mixing technique with digitally-delivered patient education. We confirmed that 1 x Nutricia® 50 ml blue scoop (BS) was equivalent to 5g of sucralose sweetener (Splenda®, supermarket own brands from Asda® & Aldi®). We calculated that one 0.5 mg/2 ml vial of budesonide should be mixed with one BS to achieve the recommended consistency of OVB. Using this novel technique for mixing OVB we recommended To further support the families, we developed a patient education leaflet and demonstration video Following these measures, we contacted thirty-two patients (age range 4 years 9 months – 17 years 10 months) (7/21 female; 14/21 male) with EoE treated with OVB under the care of a quartnary GI-allergy service. They were asked to review their experience using a standardised telephone survey. developed by the MDT. 66% (21/32) of patients responded. 86% (18/21) were using the BS technique. Of the 14% (3/21) who were not using the BS; 1 patient preferred manually weighing, 1 patient was non-compliant, and 1 patient changed treatment modality. 67% (14/21) of patients reported improved ease to make up OVB following the introduction of the BS. 29% (6/21) had only ever used the BS; therefore, were unable to comment of ease of use. 86% (18/21) of patients watched the education video; 90% (19/21) were provided with written information for mixing OVB. 100% of those who watched the video found this supportive. In conclusion, our cohort reported the introduction of the BS, educational video and written patient information improved their technique to mix OVB correctly. Further analysis is required to understand if the BS and enhanced patient education modalities improved clinical outcomes, histological remission and QOL of children with EoE treated with OVB.