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.

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+