PT - JOURNAL ARTICLE AU - Tambe, A AU - Hill, S AU - Macdonald, S TI - OC15 Use of oral spray to maintain normal B12 levels in children with short bowel syndrome and history of vitamin B12 deficiency AID - 10.1136/flgastro-2023-bspghan.15 DP - 2023 Jul 01 TA - Frontline Gastroenterology PG - A11--A12 VI - 14 IP - Suppl 1 4099 - http://fg.bmj.com/content/14/Suppl_1/A11.2.short 4100 - http://fg.bmj.com/content/14/Suppl_1/A11.2.full SO - Frontline Gastroenterol2023 Jul 01; 14 AB - Children with short bowel syndrome (SBS) are prone to long-term health consequences associated with micronutrient deficiencies.1 The shortened small intestinal length predisposes to deficiencies with ileal resection resulting in high risk of vitamin B12 deficiency leading to hematologic (megaloblastic anaemia) and neurological (myelopathy, demyelinating diseases)2 abnormalities. The standard treatment is regular intramuscularly (IM) Vitamin B12 injections if vitamin B12 blood levels are low and the child is no longer on parenteral nutrition/PN.The aim of our study was to see if vitamin B12 could be maintained in the normal range with oral vitamin B12 spray rather than regular IM injections in patients with SBS and vitamin B12 deficiency.We retrospectively reviewed children with SBS who were selected to trial oral B12 spray because they were expected to comply with treatment and in a position to purchase it. They were all weaned off PN, were regularly followed up in our clinic with regular vitamin B12 monitoring and had a history of vitamin B12 deficiency. The children were offered Boost (contains B12, green tea and chromium) oral spray as a substitute for IM injections. Children aged >12 years were prescribed 1200 µg=4 sprays/day and those aged<12 years 600ug=2 sprays/day as explained to them by the dietitian.Five children, 3 male, 2 female, aged 10 years 4 months-16 years 3 months (mean 12 yrs 10 months) when reviewed were treated with oral B12 spray. The remaining small intestinal length after neonatal intestinal resection was 7–77 cm, median 50 cm with ileo-caecal valve present in 3 children. All 5 children initially received B12 IM and were transferred to B12 spray. One child had developed a rash with B12 injections so was shifted to spray, while the other 4 preferred spray to injections. The spray had been used for 10–78(mean 31.4) months when reviewed. Serum B12 levels were 179–366 (mean 246.6)ng/L before initiation of spray. When reviewed on spray treatment vitamin B12 levels were 238–727 (mean 453.6)ng/L. None of the patients required B12 injections while they were on regular spray therapy and none of them wanted to change to IM injections. One child had to stop treatment and restart IM B12 due to oral aphthous ulceration associated with spray.In summary, our study showed that use of B12 spray maintained normal vitamin B12 levels in patients with SBS and vitamin B12 malabsorption. In conclusion, Boost vitamin B12 oral spray can be used as a substitute for IM injections in families willing to comply with therapy.3 References Stabler SP. Clinical practice. Vitamin B12 deficiency. N Engl J Med. 2013;368:149–160. Kotilea K, Quennery S, Decroës V, et al. Successful sublingual cobalamin treatment in a child with short-bowel syndrome. J Pediatr Pharmacol Ther. 2014;19:60–3. Orhan Kiliç B, Kiliç S, Şahin Eroğlu E, et al. Sublingual methylcobalamin treatment is as effective as intramuscular and peroral cyanocobalamin in children age 0–3 years. Hematology. 2021;26:1013–1017.