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| via Wikimedia Commons |
Ulcers are painful sores that form in the stomach or duodenum. Until 1982 people and doctors believed that ulcers are due to stress. Whenever a patient is diagnosed with an ulcer, the doctor would say, “You are under a lot of stress”. This was until Dr. Barry James Marshal and Robin Warren discovered that Helicobacter pylori was the main causative agent of gastric ulcers and cancer.
Barry was
born in Kalgoorlie, Australia whose father was a fixer and turner and his
mother was a nurse. His mother had nursing books and he always wanted to know why
things happened. He did well in Medical school and he was good with patients.
He accepts that lots of times he could not reach a fundamental diagnosis.
Barry
Marshal was doing his 3rd year in internal medicine and he had to take
on a project. Pathologist Robin Warren told Barry that autopsy findings of a stomach
cancer and ulcer patient showed bacteria and they all were identical. Robin
studied the bacteria and found that it had a helical form. Robin asked Barry to
study the case records of the patient to find out if there was something wrong
with them. In early 1982 Barry started a clinical trial with 100 patients and
did the paperwork. When he sent his findings to the microbiologist to culture
the bacteria and found that it was a slow-growing organism. At that time if
nothing grows in 2 days, it doesn’t exist. Fortunately, microbiologists left
the culture undisturbed for more than 2 days and found that Helicobacter
pylori is slow-growing. Barry found that he had 13 duodenal ulcer patients
and all of them had the Helicobacter pylori bacterial infection. Barry
also found that whenever a patient is diagnosed with gastric ulcer, the patient
had a history of gastritis and the only known cause of gastritis was Helicobacter
pylori.
Barry presented his works at the yearly meeting of the Royal Australasian College of Physicians in Perth. But people were not easily convinced by his work. He realized that it is going to be difficult to convince the people that ulcers are caused by bacteria and not due to stress. At that time saying that the main causative agent of ulcers is Helicobacter pylori is like saying that Earth is flat. However, Robin and Barrel wrote letters to The Lancet which described the bacteria and its history.
Barry was biopsying
every patient who came with gastric ulcer but he could not keep tabs on them. So,
he requested the pharmaceutical companies to fund him for a computer. None funded
him but he got a letter from a company that made a drug named Denzel for ulcer
which contained Bismuth. At that time drugs like Tagamet just decreased the
acid secretion and did not treat the underlying cause, it did not kill the
Helicobacter. But Bismuth-containing drugs did. The company sent “before” and “after”
photographs from which Barry found that the Before photograph had Helicobacter
but the after photograph didn’t. So, Barry applied the Bismuth-containing drug to
Helicobacter which killed it. This gave him incredible confidence. He wrote the
full paper but everything was rejected.
Though he
was treating ulcer patients successfully with antibiotics he couldn’t convince other
doctors to use antibiotics without any solid evidence. He found difficulty in
experimenting with animals. So, humans were the only option. He had a patient
with gastritis from whom he got the bacteria and cultured them. The next day,
he stirred the bacteria with a broth and drank it. Within five days his stomach
gurgled and he had a few episodes of vomiting. After 10 days his endoscopic
findings showed that he developed gastritis and the bacteria were everywhere.
Robin
Warren and Barry Marshal were jointly awarded the Nobel prize. They were the first
to identify the association between Helicobacter pylori and ulcers. They
also proved that they could kill bacteria with certain ulcer drugs. Finally, they
disproved the long-held
assumption that the ulcer was due to stress.