The effect of a low-nickel diet and nickel sensitization on gastroesophageal reflux disease: A pilot study
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ORIGINAL ARTICLE
The effect of a low-nickel diet and nickel sensitization on gastroesophageal reflux disease: A pilot study Ahmed Yousaf 1 & Rachael Hagen 2 & Mary Mitchell 3 & Erica Ghareeb 1 & Wei Fang 4 & Raoul Correa 3 & Zachary Zinn 1 & Swapna Gayam 3 Received: 15 April 2020 / Accepted: 31 August 2020 # Indian Society of Gastroenterology 2020
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
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12664-020-01090-3) contains supplementary material, which is available to authorized users. * Swapna Gayam [email protected] 1
Department of Dermatology, West Virginia University, Morgantown, WV, USA
2
West Virginia School of Osteopathic Medicine, Lewisburg, WV, USA
3
Department of Medicine, West Virginia University, Morgantown, WV, USA
4
West Virginia Clinical and Translational Science Institute, Morgantown, WV 26505, USA
The American Gastroenterological Association states that gastroesophageal reflux disease (GERD), also known as acid reflux, occurs when acid or other stomach contents back up in the esophagus. It is one of the most commonly diagnosed gastrointestinal (GI) diseases in Western countries [1]. Food allergies and sensitization of the esophageal mucosa to allergens are su
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