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Randomized Controlled Trial
. 2025 Jul 21:62:e24108.
doi: 10.1590/S0004-2803.24612024-108. eCollection 2025.

LOW-NICKEL DIET AS A STRATEGY IN THE TREATMENT OF HELICOBACTER PYLORI INFECTION

Beatriz Soares Brito  1 , Felipe Ferreira Ribeiro de Souza  1 , Daniel Machado Baptista  1 , Rafael Bandeira Lages  1 , Ricardo Correa Barbuti  1 , Tomás Navarro-Rodriguez  1
Affiliations
Randomized Controlled Trial

LOW-NICKEL DIET AS A STRATEGY IN THE TREATMENT OF HELICOBACTER PYLORI INFECTION

Beatriz Soares Brito et al. Arq Gastroenterol. .

Abstract
in English, Portuguese

Context: The rising antibiotic resistance in Helicobacter pylori (H. pylori) infection have made treatment more challenging. A low-nickel diet may improve eradication rates based on the bacteria's mechanisms.

Objective: This study aimed to evaluate the effect of a low-nickel diet during standard triple therapy on the rate of H. pylori eradication.

Methods: This randomized clinical trial included patients with H. pylori infection who were classified into the following two groups: low-nickel diet and regular diet. Both groups received the standard triple therapy with amoxicillin, clarithromycin, and a proton pump inhibitor. After at least 8 weeks of treatment, a control test for H. pylori was performed.

Results: Per-protocol analysis showed a higher rate of H. pylori eradication in the low-nickel diet group than in the regular diet group (91.7% vs 75.8%; P=0.026). In addition, obesity was associated with poorer eradication rates (73.2% vs 88.9%, P=0.038). Patients on a low-nickel diet were 3.41 times (1.21-11.40) more likely to have H. pylori eradication than those on a normal diet.

Conclusion: This study showed that low-nickel diet, which is a low-cost and low-risk intervention, may be an appropriate strategy for increasing H. pylori eradication rates.

Background: • Evaluate the effect of low-nickel diet during standard triple therapy on the rate of Helicobacter pylori eradication.

Background: • This randomized clinical trial included patients infected with Helicobacter pylori in groups with a low-nickel nickel or regular diet, who underwent standard triple therapy and the efficacy of bacterial eradication was compared between both groups.

Background: • Per-protocol analysis showed a higher rate of Helicobacter pylori eradication in the low-nickel diet group than in the regular diet group (91.7% vs 75.8%; P=0.026).

Background: • The low-nickel diet is an appropriate strategy for increasing Helicobacter pylori eradication rates.

Contexto:: O aumento das taxas de resistência aos antibióticos na infecção por Helicobacter pylori (H. pylori) tem tornado o tratamento desafiador. Uma dieta pobre em níquel pode melhorar as taxas de erradicação com base nos mecanismos da bactéria.

Objetivo:: Este estudo teve como objetivo avaliar o efeito de uma dieta pobre em níquel durante a terapia tripla padrão nas taxas de erradicação do H. pylori.

Métodos:: Este ensaio clínico randomizado incluiu pacientes com infecção por H. pylori, classificando-os em dois grupos: dieta pobre em níquel e dieta padrão. Ambos os grupos receberam terapia tripla padrão com amoxicilina, claritromicina e um inibidor da bomba de prótons. Um exame de controle de cura do H. pylori foi realizado após pelo menos 8 semanas do tratamento.

Resultados:: A análise por protocolo revelou uma taxa de erradicação mais alta no grupo da dieta pobre em níquel em comparação ao grupo da dieta padrão (91,7% vs 75,8%; P=0,026). Além disso, a obesidade estava associada a taxas de erradicação mais baixas (73,2% vs 88,9%; P=0,038). Pacientes em uma dieta pobre em níquel tinham 3,41 vezes mais chances (1,21-11,40) de erradicação do H. pylori em comparação aos que estavam em uma dieta padrão.

Conclusão:: Este estudo sugere que uma dieta pobre em níquel, intervenção econômica e de baixo risco, pode aumentar as taxas de erradicação do H. pylori.

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Conflict of interest statement

Declared conflict of interest of all authors: none

Figures

FIGURE 1.
FIGURE 1.. Representative schematic of the relationship between urease and hydrogenase activity and nickel metabolism. Nickel is transported into the Helicobacter pylori cytoplasm via the NixA transporter. Once inside the cell, nickel activates both urease and hydrogenase enzymes, leading to the production of nitrogenous compounds and enhancing the bacterium’s resistance to gastric acidity.
FIGURE 2.
FIGURE 2.. Flowchart of study population.
See this image and copyright information in PMC

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