Yousaf, Hagen, Mitchell, Ghareeb, Fang, Correa, Zinn, Gayam 2021 — Low-nickel diet and gastroesophageal reflux disease: a pilot study
This Indian Journal of Gastroenterology pilot trial from West Virginia University Departments of Dermatology, Internal Medicine, and Clinical and Translational Science tests whether a low-nickel diet reduces GERD symptoms in refractory patients and whether epicutaneous patch testing to nickel predicts diet responsiveness. 20 patients with refractory GERD (measured by GERD-HRQL) underwent patch testing and an 8-week low-nickel diet. The headline finding: 19 of 20 patients (95 percent) had GERD-HRQL symptom-severity reduction at 8 weeks; the response was not predicted by patch-test positivity. The implication challenges the standard clinical framework that nickel sensitivity (and the therapeutic relevance of low-Ni diet) tracks with positive patch testing.
Key numbers
| Outcome | Result |
|---|---|
| GERD-HRQL responders at 8 weeks | 19 of 20 (95 percent) |
| Patch-test-positive responders | Did not differ from patch-test-negative responders |
| Endoscopic improvement | Documented in the responder cohort |
Both patch-test-positive and patch-test-negative GERD patients responded to the low-nickel diet, suggesting nickel-related GI symptoms are not exclusively mediated through type IV (delayed-type hypersensitivity) immune mechanisms. This is a major finding for the SNAS-vs-broader-nickel-sensitivity debate.
Methods (brief)
Single-site prospective pilot study. Inclusion: refractory GERD by GERD-HRQL. Intervention: 8-week low-nickel diet (Italian Allergological Society protocol). Pre- and post- patch testing to nickel sulfate at standard concentration. GERD-HRQL and Bravo pH testing where applicable.
Implications
- Certification: Demonstrates that low-nickel-diet benefits extend beyond patch-test-positive nickel-allergic individuals, broadening the population for whom dietary Ni reduction is clinically meaningful. Relevant to HMTc Ni-threshold rationale for broader vulnerable populations than the EFSA-acute-LOAEL framework recognizes.
- Microbiome / GI: Plausible mechanism is Ni-driven H. pylori virulence (companion to Campanale 2014) plus Ni-driven barrier dysfunction (Ghosh 2024).
- Courses: Standard recent reference for nickel and refractory GERD.
Wiki pages updated on ingest
Page history
The five most recent substantive edits to this page. The full version history lives in git; when DOI minting comes online (see schema docs), each entry below will also link to a version-pinned DataCite DOI.
| Commit | Date | Description |
|---|---|---|
| b0f3d38 | 2026-06-12 | batch | corpus rescreen b04 old terminal skips |