title: Nickel free-diet enhances the Helicobacter pylori eradication rate: a pilot study.
abstract: BACKGROUND
  The Helicobacter pylori eradication rate with standard triple therapy is very low. H. pylori is known to require the nickel-containing metalloenzymes urease and NiFe-hydrogenase to survive at the low pH environment in the stomach.
  
  
  OBJECTIVE
  To compare the H. pylori eradication rate of a nickel free-diet associated with standard triple therapy and standard triple therapy alone as the first-line regimen.
  
  
  METHODS
  Fifty-two sex- and age-matched patients at the first diagnosis of H. pylori infection were randomized 1:1 into two different therapeutic schemes: (1) standard LCA (26 patients): lansoprazole 15 mg bid, clarithromycin 500 mg bid and amoxicillin 1,000 mg bid for 7 days with a common diet; (2) standard LCA plus a nickel free-diet (NFD-LCA) (26 patients). Patients followed 30 days of a nickel-free diet plus a week of lansoprazole 15 mg bid, clarithromycin 500 mg bid and amoxicillin 1,000 mg bid starting from day 15 of the diet.
  
  
  RESULTS
  All patients completed the study. A significantly higher eradication rate was observed in the NFD-LCA group (22/26) versus LCA group (12/26) (p < 0.01). Only a few patients (9 of 52) reported the occurrence of mild therapy-related side effects, without any significant differences between the two groups.
  
  
  CONCLUSIONS
  The addition of a nickel-free diet to standard triple therapy significantly increases the H. pylori eradication rate. The reduction of H. pylori urease activity due to the nickel-free diet could expose the bacterium to gastric acid and increase H. pylori's susceptibility to amoxicillin. Further studies are necessary to confirm this preliminary result.
authors.affiliation: Internal Medicine and Endoscopy, Gemelli Hospital, Largo A. Gemelli, 8, 00168, Rome, Italy, chiaracampanale@hotmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Campanale
authors.forename: E
authors.initials: E
authors.lastname: Nucera
authors.forename: V
authors.initials: V
authors.lastname: Ojetti
authors.forename: V
authors.initials: V
authors.lastname: Cesario
authors.forename: T A
authors.initials: TA
authors.lastname: Di Rienzo
authors.forename: G
authors.initials: G
authors.lastname: D'Angelo
authors.forename: S
authors.initials: S
authors.lastname: Pecere
authors.forename: F
authors.initials: F
authors.lastname: Barbaro
authors.forename: G
authors.initials: G
authors.lastname: Gigante
authors.forename: T
authors.initials: T
authors.lastname: De Pasquale
authors.forename: A
authors.initials: A
authors.lastname: Rizzi
authors.forename: G
authors.initials: G
authors.lastname: Cammarota
authors.forename: D
authors.initials: D
authors.lastname: Schiavino
authors.forename: F
authors.initials: F
authors.lastname: Franceschi
authors.forename: A
authors.initials: A
authors.lastname: Gasbarrini
mesh_terms: D000328:Adult; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D017291:Clarithromycin / Q000627:therapeutic use; D000075202:Contraindications; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000178:diet therapy* / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects; D006801:Humans; D064747:Lansoprazole / Q000627:therapeutic use; D008297:Male; D009532:Nickel; D010865:Pilot Projects
chemical_list: D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D064747:Lansoprazole; D009532:Nickel; D000658:Amoxicillin; D017291:Clarithromycin