Nickel-Related Intestinal Mucositis in IBS-Like Patients: Laser Doppler Perfusion Imaging and Oral Mucosa Patch Test in Use

Abstract

Nickel (Ni) is often the trigger of irritable bowel syndrome (IBS)-like gastrointestinal disorders: its ingestion may cause allergic contact mucositis, identifiable by means of oral mucosa patch test (omPT). OmPT effectiveness has been proven, but it is still an operator-dependent method. Laser Doppler perfusion imaging (LDPI) was tested to support omPT in Ni allergic contact mucositis diagnosis. Group A: 22 patients with intestinal/systemic symptoms related to the ingestion of Ni-containing foods. Group B: 12 asymptomatic volunteers. Ni-related symptoms and their severity were tested by a questionnaire. All patients underwent Ni omPT with clinical evaluation at baseline (T0), after 30 min (T1), after 2 h (T2), and after 24-48 h (T3). LDPI was performed to evaluate the mean mucosal perfusion at T0, T1, and T2. Statistical analysis was performed by ANOVA test and Bonferroni multiple-comparison test. All 22 Ni-sensitive patients (group A) presented oral mucosa hyperemia and/or edema at T2. Eight out of the same 22 patients presented a local delayed vesicular reaction at T3 (group A1), unlike the remaining 14 out of 22 patients (group A2). All 12 patients belonging to control group B did not show any alteration. The mean mucosal perfusion calculated with LDPI showed an increase in both subgroups A1 and A2. In group B, no significant perfusion variations were observed. LDPI may support omPT for diagnostic purposes in Ni allergic contact mucositis. This also applies to symptomatic Ni-sensitive patients without aphthous stomatitis after 24-48 h from omPT and that could risk to miss the diagnosis.

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

“…Symptoms triggered by the ingestion of Ni-rich foods in Ni-sensitive patients are mainly gastrointestinal, but they can also be systemic, involving the skin, the nervous and the reproductive system [49]. A low-Ni diet can improve symptoms in Ni-sensitive patients, though foods high in Ni are largely consumed, especially in the Mediterranean diet, such as tomatoes, cocoa, beans, mushrooms, broadleaf vegetables, and whole flour [47]. As Ni ePT is useful for the diagnosis of Ni ACD, so Ni omPT has proved to be a specific and sensitive tool for Ni ACM diagnosis [5,47,[49][50][51].…”

“…Gastrointestinal symptoms in endometriosis may also be related to IBS or IBS-like disorders [45]. Recent studies showed a higher prevalence of Ni skin allergy in women with endometriosis, as well as a possible Ni involvement in its etiopathogenesis [20,46,47]. On these bases, it is possible to hypothesize that an IBS-like disorder, such as Ni ACM, may be the cause or contributing factor of gastrointestinal symptoms in women with endometriosis.…”

“…Aphthous/vesicular lesions may also appear even after 24-48 hours as late reactions. Late general symptoms triggered by omPT (such as swelling and abdominal pain, diarrhea, headache, foggy mind, itching, dermography) should also be considered [47].…”

Does Irritable Bowel Syndrome Exist? Identifiable and Treatable Causes of Associated Symptoms Suggest It May Not

“…Diagnosis of dietary nickel sensitivity can be performed with a skin or oral mucosa patch test [110,112]. All patients reporting to a gastroenterology unit with IBS symptoms and suspected sensitivity to nickel containing foods had a positive response to an oral mucosa patch test characterized by local hyperemia and/or edema, compared to no response in a control group [113]. Beyond implementation of a low nickel diet, nutritional detoxification strategies have been proposed but currently lack clinical evidence [114].…”

Association between buccal mucosa ridging and oral or occlusal status among older people

“…It is caused by the compression and thickening of the oral mucosal epithelium in response to mechanical stimulus, but it is not considered a pathological condition (Kumakura, Sakurai, Tahara, & Nakagawa, ). BMR can be easily distinguished from pathological conditions, such as lichen planus, leukoplakia, or allergic mucositis, which are associated with pain, erosions, ulcers, lace‐like leucoderma, or pseudomembrane formation (Borghini et al., ; Gupta, Gupta, Urs, & Singh, ; He et al., ). BMR observed along the occlusal plane was described as a sign of clenching, a characteristic of bruxism (Kampe, Tagdae, Bader, Edman, & Karlsson, ).…”