Adrenal Insufficiency in Children with Eosinophilic Esophagitis Treated with Topical Steroids

an ABP content topic (pediatric pancreatitis) consisting of 10 multiple-choice questions along with links to sentinel readings (Figure 1). The module focused on current literature in a structured format and could be tracked by the creator for fellow completion and competency. If fellows answered a question correctly, they could move on to the next question. All answers were linked to specific reference texts; fellows could save articles for future use. In the subsequent didactic one week later, the module author reviewed the questions with the fellows and obtained accuracy-related feedback. Quality surveys were administered pre and post module completion. RESULTS: All fellows (n=7) completed this module (completion time: 20.2±16.8 min) and pre/post quality surveys (2 PL-4's, 2 PL5, 3 PL-6's). Table 1 compares the perceived session quality before and after module implementation. The quality of the modules was reported to be stronger than the previous session format. A majority of the fellows strongly agreed that the module information was valuable (71%), applicable, of excellent quality (71%), up to date (71%), effectively delivered (71%), allowed for group discussion (86%), and promoted self-directed (57%) and active learning (71%). Additionally, 71.4% of the fellows strongly agreed that they were satisfied with the flipped classroom format. CONCLUSION: Our unique web-based curriculum pilot module leads to increased participation when compared to traditional self-directed learning and improved fellow satisfaction. Additionally, fellows find the module clinically applicable, more effective, and current, while facilitating active- and self-directed learning. Furthermore, this format allows for faculty to actively track completion, assess knowledge, retention, and test-taking skills. This format has the potential to encompass trainee curricula within and outside our field. Comparison of Session Quality Before and After Module Implementation

AGA Abstracts

the use of a CPOE alert and provider educational intervention. We had no C. difficileassociated complications in the group that tested positive for C .difficile post-CPOE alert, suggesting that any potential delays in testing associated with this alert did not result in unintended adverse outcomes. Table 1. C. difficile tests ordered per 10,000 patient days

Figure 1. Poisson regression modeled over time stratified by age. A significant change was noted in monthly testing rates over time (p < 0.001) and by age (p < 0.001).

Sa2063 ADRENAL INSUFFICIENCY IN CHILDREN WITH EOSINOPHILIC ESOPHAGITIS TREATED WITH TOPICAL STEROIDS Paroma Bose, Todd D. Nebesio, Emily C. Hon, Sandeep K. Gupta Background: Adrenal insufficiency (AI) is often caused by exogenous steroid use and can be life threatening in times of stress or acute illness. Limited data is available on AI in children with eosinophilic esophagitis (EoE), where swallowed topical steroids are a mainstay of therapy. Studies suggest a prevalence of AI of 10-43% in EoE patients on topical steroids. Aims: To identify the prevalence of AI in pediatric EoE patients treated with topical steroids, and to compare dehydroepiandrosterone sulfate (DHEA-S) to morning serum cortisol as a screening tool for AI. Methods: Children with EoE treated with topical steroids for ≥ 6 months were evaluated for AI with morning serum cortisol levels and, if indicated, confirmatory modified low-dose adrenocorticotropic hormone (ACTH) stimulation testing. Serum cortisol levels were measured at baseline, 20, 40, and 60 minutes. AI was defined by peak serum cortisol level < 18mcg/dL. DHEA-S levels were also obtained and compared with morning serum cortisol levels. Electronic medical records were reviewed for demographics, disease information, and treatment data. Results: Thirty-seven patients with EoE [mean age 9.4 (2-18) years, 22% female] had morning serum cortisol measured. Treatment for EoE included budesonide (68%) and fluticasone (32%), and the average duration of treatment was 20.9 months. 19/37 (51%) had a low morning serum cortisol level (< 10mcg/dL). ACTH stimulation testing was abnormal in 2/10 patients, with an overall AI prevalence of 5% (2/ 37) in EoE patients being treated with topical steroids. Clinical factors such as age, gender, body mass index (BMI), duration of therapy, and type of steroid did not differ significantly between normal and abnormal ACTH stimulation test responders. BMI was significantly lower in children with low morning serum cortisol levels compared to those with normal levels (p = 0.04). DHEA-S and morning serum cortisol levels had a correlation coefficient of 0.44 (p = 0.03). Conclusions: Prevalence of AI in this cohort is lower than previously described, and this is consistent with our historical impressions of managing such patients over the last 20 years. BMI may be a predictor of development of AI. DHEA-S has a correlation with morning serum cortisol. More data is required to assess utility of DHEA-S as a screening tool for AI, since unlike serum cortisol levels, DHEA-S does not have a diurnal rhythm.

Key: SD: Strongly Disagree; D: Disagree; N: Neutral; A: Agree; SA: Strongly Agree; NA: Not Applicable a: Number of responses (%)

Sa2064 NOVEL WEB-BASED PILOT PEDIATRIC GI FELLOWSHIP CURRICULUM LEADS TO IMPROVED UTILIZATION AND USER SATISFACTION Arvind I. Srinath, Sandra C. Kim, James B. McGee BACKGROUND: The ACGME currently recommends didactic, self-directed learning modalities for trainees in medical knowledge acquisition. Like most fellowship programs, we traditionally have used weekly didactics on general GI topics using a standard textbook; topics are chosen based on need gleaned by fellow evaluations. However, fellows have raised concerns over a) passive learning style, b) textbooks being out of date, c) absence of clinical correlation, and d) author bias. We thus piloted a unique learning tool employing the flipped classroom format that aligned the fellow curriculum with the American Board of Pediatrics (ABP) content while accounting for fellow time limitations and lack of assessment of fellow preparedness. We hypothesized this interactive learning model would lead to increased fellow participation and satisfaction. METHODS: We created a web-based module based on

AGA Abstracts

S-436