The effect of a low-nickel diet and nickel sensitization on gastroesophageal reflux disease: A pilot study

Abstract

Background/aims: Gastroesophageal reflux disease (GERD) is a common medical condition, frequently refractory to medical therapy. Nickel is a leading cause of allergic contact dermatitis. Although nickel is widely found in foods, the effect of nickel on GERD is unknown. This pilot study sought to evaluate the effect of a low-nickel diet on GERD and determine if epicutaneous patch testing to nickel could predict responsiveness to a low-nickel diet.

Methods: This prospective, single-site pilot study recruited 20 refractory GERD patients as determined by GERD Health-Related Quality of Life (GERD-HRQL) scores. All patients had epicutaneous patch testing for nickel and were then instructed to follow a low-nickel diet for 8 weeks regardless of patch test results. GERD-HRQL was recorded at baseline and following 8 weeks of a low-nickel diet. Demographic and clinical data associated with GERD and nickel allergy were recorded. A Wilcoxon signed-rank test and nonparametric analysis of longitudinal data were run to determine statistical significance in pre- and post- GERD-HRQL scores in nickel patch test-positive and negative groups.

Results: Nearly all (19/20 [95%]) participants reported reduced GERD symptoms after 8 weeks on a low-nickel diet. Mean total GERD-HRQL, regurgitation, and heartburn scores declined (27.05 ± 16.04, 11.45 ± 6.46, 10.85 ± 8.29). Participants with positive vs. negative patch testing to nickel responded equivalently to a low-nickel diet.

Conclusions: A low-nickel diet improves GERD symptoms, but responsiveness to a low-nickel diet does not correlate with epicutaneous patch testing to nickel.

Trial registration: ClinicalTrials.gov number: NCT03720756.

Keywords: Dietary treatment; Esophagus; Food allergy; Gastroesophageal reflux disease; Nickel; Patch test.

Conflict of interest statement

Conflict of interest AY, RH, MM, EG, WF, RC, ZZ, and SG declare that they have no conflict of interest. All authors had access to study data and approved the final manuscript.

Figures

Fig. 1

GERD-HRQL score change following low-nickel diet implementation. A candlestick chart depicts the change in GERD-HRQL scores of study participants who completed the 8-week low-nickel diet. A decline in GERD symptom severity is noted in green, while worsening symptom severity is noted in red. Asterisk indicates nickel allergy positive–participants with at least 1+ on patch testing according to ICDRG criteria. GERD gastroesophageal reflux disease, HRQL health-related quality of life, ICDRG International contact dermatitis research group

Fig. 2

Weak positive reaction at 48 and 96 h. a At 48 h, palpable erythema (arrow) is noted on the upper back located at the site of nickel sulfate hexahydrate Finn Chambers AQUA® (Smart Practice, Phoenix, Arizona, US) system occlusion. b At 96 h, the erythema and infiltration (arrow) have spread to all skin contacted by nickel sulfate hexahydrate. According to International contact dermatitis research group criteria, this patch test was read as 1+