Nobel Laureates · Nº 04

Ulcers

Every doctor knew nothing survives stomach acid. One doctor drank the proof.
8 cards · The world, by the numbers.
01 / 08
Nothing lives in acid
the thing every doctor knew…
Every medical student learned it. The stomach is a vat of acid strong enough to strip paint, and nothing survives in there. Ulcers came from stress and sharp food, and the treatment was to manage them, for life.
Pre-1980s consensus: peptic ulcers attributed to stress and acid; sterile-stomach dogma.
02 / 08
1979
a pathologist keeps seeing something…
In Perth, a pathologist named Robin Warren kept finding curved bacteria in stomach biopsies. They were plainly there, sample after sample. Colleagues told him it was contamination, or a staining artefact, or simply not important.
Robin Warren observed spiral bacteria in gastric biopsies from 1979 at Royal Perth Hospital.
03 / 08
Bottom ten per cent
how the profession ranked it…
When Warren and a young registrar named Barry Marshall submitted their findings to Australia's gastroenterology society, the reviewers ranked the work in the bottom ten per cent of everything they received that year.
1983: abstract rejected by the Gastroenterological Society of Australia, rated in the bottom 10%.
04 / 08
1984
so he settled it himself…
Marshall had a technician scrape two petri dishes of the bacteria into beef broth, and drank it. Within days he was vomiting. On day eight a camera found his stomach raw with inflammation, and the bacteria growing in it.
July 1984, Fremantle Hospital: Marshall ingested H. pylori culture; day-8 endoscopy showed gastritis.
05 / 08
He told no ethics committee
and did not tell his wife either…
He had no approval for any of it. He did not go to the ethics committee, and by his own account did not tell his wife until afterwards. It worked, and it made him right. Medicine still does not recommend the method.
Marshall's self-experiment was undertaken without formal ethics approval.
06 / 08
2005
twenty-one years after the glass…
Warren and Marshall shared the Nobel Prize in Medicine, for the discovery of Helicobacter pylori and its role in gastritis and ulcers. A bacterium the whole profession had been looking straight at, for years.
2005 Nobel Prize in Physiology or Medicine: Barry J. Marshall and J. Robin Warren.
07 / 08
A disease stopped being chronic
what changed in the wards…
Before, a severe ulcer meant a lifetime of acid suppression and sometimes a surgeon removing part of your stomach. Afterwards it meant an infection. The same disease, reclassified — and the operating theatres emptied.
Reclassification of peptic ulcer disease as infectious; sharp decline in ulcer surgery.
08 / 08
1 week
and the ulcer is simply gone…
Today a course of antibiotics clears it in about a week. The same bacterium is the leading cause of stomach cancer, so curing an ulcer now sometimes prevents one. All of it began with a man who drank his own evidence.
H. pylori eradication therapy ~1-2 weeks; H. pylori is the leading risk factor for gastric cancer.

Sources

  1. Pre-1980s consensus: peptic ulcers attributed to stress and acid; sterile-stomach dogma.
  2. Robin Warren observed spiral bacteria in gastric biopsies from 1979 at Royal Perth Hospital.
  3. 1983: abstract rejected by the Gastroenterological Society of Australia, rated in the bottom 10%.
  4. July 1984, Fremantle Hospital: Marshall ingested H. pylori culture; day-8 endoscopy showed gastritis.
  5. Marshall's self-experiment was undertaken without formal ethics approval.
  6. 2005 Nobel Prize in Physiology or Medicine: Barry J. Marshall and J. Robin Warren.
  7. Reclassification of peptic ulcer disease as infectious; sharp decline in ulcer surgery.
  8. H. pylori eradication therapy ~1-2 weeks; H. pylori is the leading risk factor for gastric cancer.

Image credits

  1. HelicobacterPylori2.jpg — Hpylori.jpg: * Photo Credit: Janice Carr, Public domain · Commons
  2. Human Anatomy (NIH BioArt 519 - 657942).png — Courtesy of NIAID, Public domain · Commons
  3. Close-up of a lab technitian adjusting a microscope glass slide.jpg — Shixart1985, CC BY 2.0 · Commons
  4. Olivetti Lettera 82 portable mechanical typewriter.jpg — Suyash Dwivedi, CC BY-SA 4.0 · Commons
  5. Barry Marshall - Sample Jar - Nobel Musem, Stockholm.jpg — Gaius Cornelius, CC BY 4.0 · Commons
  6. Dr Barry Marshall - Nobel Laureate.jpg — Binarysequence, CC BY-SA 4.0 · Commons
  7. Stockholm Konserthuset 2002.jpg — wishes to remain anonymous, CC BY-SA 3.0 · Commons
  8. Surgeon operating in the ward of a hospital. Wellcome M0007317.jpg — Unknown, CC BY 4.0 · Commons
  9. Antibiotic pills.jpg — Maksym Kozlenko, CC BY-SA 4.0 · Commons

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