Irritable Bowel Syndrome-Like Disorders in Endometriosis: Prevalence of Nickel Sensitivity and Effects of a Low-Nickel Diet. An Open-Label Pilot Study

Overview

Journal Nutrients

Date 2020 Feb 5

PMID 32012984

Citations 20

Authors

Raffaele Borghini

Maria Grazia Porpora

Rossella Casale

Mariacatia Marino

Emilia Palmieri

Nicoletta Greco

Giuseppe Donato

Antonio Picarelli

Affiliations

Soon will be listed here.

Abstract

Alimentary nickel (Ni) may result in allergic contact mucositis (ACM), whose prevalence is >30% and may present with IBS-like and extra-intestinal symptoms. These symptoms are also frequent in endometriosis, and Ni allergic contact dermatitis has already been observed in endometriosis. Therefore, intestinal and extra-intestinal symptoms in endometriosis may depend on a Ni ACM, and a low-Ni diet could improve symptoms. We studied the prevalence of Ni ACM in endometriosis and focused on the effects of a low-Ni diet on gastrointestinal, extra-intestinal, and gynecological symptoms. We recruited 84 women with endometriosis, symptomatic for gastrointestinal disorders. Thirty-one out of 84 patients completed the study. They underwent Ni oral mucosa patch test (omPT), questionnaire for intestinal/extra-intestinal/gynecological symptoms, and a low-Ni diet. Clinical evaluation was performed at baseline (T0) and after three months (T1). Twenty-eight out 31 (90.3%) patients showed Ni omPT positive results, with Ni ACM diagnosis, whereas three out of 31 (9.7%) patients showed negative Ni omPT. After three months of low-Ni diet, all gastrointestinal, extra-intestinal and gynecological symptoms showed a statistically significant reduction. Ni ACM has a high prevalence in endometriosis and a low-Ni diet may be recommended in this condition to reduce gastrointestinal, extra-intestinal and gynecological symptoms.

Citing Articles

Endometriosis in Adolescence: A Narrative Review of the Psychological and Clinical Implications.

Panvino F, Paparella R, Pisani F, Tarani F, Ferraguti G, Fiore M Diagnostics (Basel). 2025; 15(5).

PMID: 40075795 PMC: 11898908. DOI: 10.3390/diagnostics15050548.

Dietary and Nutritional Interventions for the Management of Endometriosis.

Abulughod N, Valakas S, El-Assaad F Nutrients. 2024; 16(23).

PMID: 39683382 PMC: 11643425. DOI: 10.3390/nu16233988.

Holistic approaches to living well with endometriosis.

Desai J, Strong S, Ball E F1000Res. 2024; 13():359.

PMID: 39649833 PMC: 11621616. DOI: 10.12688/f1000research.142586.2.

Endometriosis, Pain, and Related Psychological Disorders: Unveiling the Interplay among the Microbiome, Inflammation, and Oxidative Stress as a Common Thread.

Cuffaro F, Russo E, Amedei A Int J Mol Sci. 2024; 25(12).

PMID: 38928175 PMC: 11203696. DOI: 10.3390/ijms25126473.

Low Diet Quality and Nutritional Knowledge in Women with Endometriosis: A Pilot Study.

Bogusz A, Gornicka M Healthcare (Basel). 2024; 12(6).

PMID: 38540637 PMC: 10970578. DOI: 10.3390/healthcare12060673.

References

Kennedy S, Bergqvist A, Chapron C, DHooghe T, Dunselman G, Greb R . ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod. 2005; 20(10):2698-704. DOI: 10.1093/humrep/dei135. View

Ohlsson B . Gonadotropin-Releasing Hormone and Its Physiological and Pathophysiological Roles in Relation to the Structure and Function of the Gastrointestinal Tract. Eur Surg Res. 2016; 57(1-2):22-33. DOI: 10.1159/000445717. View

Barceloux D . Nickel. J Toxicol Clin Toxicol. 1999; 37(2):239-58. DOI: 10.1081/clt-100102423. View

Tokushige N, Markham R, Russell P, Fraser I . High density of small nerve fibres in the functional layer of the endometrium in women with endometriosis. Hum Reprod. 2005; 21(3):782-7. DOI: 10.1093/humrep/dei368. View

Stratton P, Berkley K . Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications. Hum Reprod Update. 2010; 17(3):327-46. PMC: 3072022. DOI: 10.1093/humupd/dmq050. View

Picarelli A, Di Tola M, Vallecoccia A, Libanori V, Magrelli M, Carlesimo M . Oral mucosa patch test: a new tool to recognize and study the adverse effects of dietary nickel exposure. Biol Trace Elem Res. 2010; 139(2):151-9. DOI: 10.1007/s12011-010-8652-y. View

Porpora M, Koninckx P, Piazze J, Natili M, Colagrande S, Cosmi E . Correlation between endometriosis and pelvic pain. J Am Assoc Gynecol Laparosc. 1999; 6(4):429-34. DOI: 10.1016/s1074-3804(99)80006-1. View

Lea R, Whorwell P . Irritable bowel syndrome or endometriosis, or both?. Eur J Gastroenterol Hepatol. 2003; 15(10):1131-3. DOI: 10.1097/00042737-200310000-00012. View

Vercellini P, Crosignani P, Somigliana E, Vigano P, Frattaruolo M, Fedele L . 'Waiting for Godot': a commonsense approach to the medical treatment of endometriosis. Hum Reprod. 2010; 26(1):3-13. DOI: 10.1093/humrep/deq302. View

10.

Borghini R, Puzzono M, Rosato E, Di Tola M, Marino M, Greco F . Nickel-Related Intestinal Mucositis in IBS-Like Patients: Laser Doppler Perfusion Imaging and Oral Mucosa Patch Test in Use. Biol Trace Elem Res. 2016; 173(1):55-61. DOI: 10.1007/s12011-016-0650-2. View

11.

Yuk J, Shin J, Shin J, Oh E, Kim H, Park W . Nickel Allergy Is a Risk Factor for Endometriosis: An 11-Year Population-Based Nested Case-Control Study. PLoS One. 2015; 10(10):e0139388. PMC: 4594920. DOI: 10.1371/journal.pone.0139388. View

12.

Bruner-Tran K, Yeaman G, Crispens M, Igarashi T, Osteen K . Dioxin may promote inflammation-related development of endometriosis. Fertil Steril. 2008; 89(5 Suppl):1287-98. PMC: 2430157. DOI: 10.1016/j.fertnstert.2008.02.102. View

13.

Rizzi A, Nucera E, Laterza L, Gaetani E, Valenza V, Corbo G . Irritable Bowel Syndrome and Nickel Allergy: What Is the Role of the Low Nickel Diet?. J Neurogastroenterol Motil. 2017; 23(1):101-108. PMC: 5216640. DOI: 10.5056/jnm16027. View

14.

Martin M, Reiter R, Pham T, Avellanet Y, Camara J, Lahm M . Estrogen-like activity of metals in MCF-7 breast cancer cells. Endocrinology. 2003; 144(6):2425-36. DOI: 10.1210/en.2002-221054. View

15.

Remorgida V, Ferrero S, Fulcheri E, Ragni N, Martin D . Bowel endometriosis: presentation, diagnosis, and treatment. Obstet Gynecol Surv. 2007; 62(7):461-70. DOI: 10.1097/01.ogx.0000268688.55653.5c. View

16.

Byrne C, Divekar S, Storchan G, Parodi D, Martin M . Metals and breast cancer. J Mammary Gland Biol Neoplasia. 2013; 18(1):63-73. PMC: 4017651. DOI: 10.1007/s10911-013-9273-9. View

17.

Eskenazi B, Warner M, Bonsignore L, Olive D, Samuels S, Vercellini P . Validation study of nonsurgical diagnosis of endometriosis. Fertil Steril. 2001; 76(5):929-35. DOI: 10.1016/s0015-0282(01)02736-4. View

18.

Lappano R, Malaguarnera R, Belfiore A, Maggiolini M . Recent advances on the stimulatory effects of metals in breast cancer. Mol Cell Endocrinol. 2016; 457:49-56. DOI: 10.1016/j.mce.2016.10.017. View

19.

Schroder A, Diedrich K, Ludwig M . Medical management of endometriosis: a systematic review. IDrugs. 2004; 7(5):451-63. View

20.

Wittsiepe J, Schnell K, Hilbig A, Schrey P, Kersting M, Wilhelm M . Dietary intake of nickel and zinc by young children--results from food duplicate portion measurements in comparison to data calculated from dietary records and available data on levels in food groups. J Trace Elem Med Biol. 2009; 23(3):183-94. DOI: 10.1016/j.jtemb.2009.03.007. View