# Effectiveness of Physiologic Testing in PPI Non-Responders

> **NIH NIH R01** · NORTHWESTERN UNIVERSITY · 2020 · $314,559

## Abstract

Project Summary
The prevalence of gastroesophageal reflux disease is estimated to be as high as 20% in the United States,
and up to 50% of these patients remain symptomatic on proton pump inhibitor (PPI) therapy. Unfortunately, the
clinical approach to understand the mechanism of nonresponse is not standardized, and patients will often
undergo various esophageal function tests: 1) pH-impedance, 2) wireless pH monitoring over 96 hours, 3)
high-resolution impedance manometry (HRIM), and 4) mucosal impedance. Currently significant controversy
exists regarding the best technique, optimal study protocol and treatment approach for the PPI non-responder
(PPINR) group, resulting in inappropriate resource utilization and a failure to provide effective personalized
care. As such, PPINRs contribute to a large healthcare burden in the United States.
The first aim of our study is to identify the relevant physiologic parameters of the aforementioned diagnostic
tools in their ability to predict PPI requirement. Subsequently, in aim two these results will be applied to guide
the formal development of a clinical algorithm for the management of PPINRs with personalized clinical
pathways based on mechanism of treatment failure.
We will first perform a prospective comparison trial of 240 PPINR subjects at two centers over a 4 year period.
Subjects will complete symptom questionnaires and undergo diagnostic testing (pH-impedance on PPI
therapy, HRIM, 96-hour wireless pH monitoring off of PPI therapy and mucosal impedance).
Those who have a
positive pH study and/or resume PPI therapy will receive escalation of acid suppression therapy with
dexlansoprazole. Experiments 1a & 1b will compare the ability of 96-hour wireless pH monitoring vs pH
impedance to predict PPI requirement and response to dexlansoprazole, respectively.
 Experiment 1c will
explore whether mucosal impedance is equivalent to 96-hour wireless pH monitoring in predicting PPI
requirement. Lastly, Experiment 1d will determine whether HRIM metrics can be utilized to determine reflux
burden, mechanism and response to treatment. Next, we will develop quality measures for reflux testing in
order to develop a simplified management strategy for the PPINR group. The RAND/UCLA Appropriateness
Methodology will be utilized with an expert working group to develop formal validated quality measures for
reflux testing based on results from aim 1 in addition to the available literature & evidence.
This will be
conducted over twelve-months (years 4 to 5).

## Key facts

- **NIH application ID:** 9897552
- **Project number:** 5R01DK092217-07
- **Recipient organization:** NORTHWESTERN UNIVERSITY
- **Principal Investigator:** JOHN E PANDOLFINO
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $314,559
- **Award type:** 5
- **Project period:** 2012-04-01 → 2022-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9897552

## Citation

> US National Institutes of Health, RePORTER application 9897552, Effectiveness of Physiologic Testing in PPI Non-Responders (5R01DK092217-07). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9897552. Licensed CC0.

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