I know what you’re saying – what on earth is H. pylori infection and have I got it? I want to tell you a story of two amazing researchers who discovered why we get stomach ulcers and even proved it. Trouble was, nobody would take any notice of them. Why? Because the powers that be and those that vetted all new research and cures, ignored their work because it went against everything previously taught. It was pure dogma and closed-mindedness. H. pylori stands for Helicobacter pylori a then unknown bacteria.
Dr Robin Warren
So who am I talking about? I’m speaking initially of Dr Robin Warren, a pathologist at the Royal Perth Hospital (RPH) in W. Australia. In 1979, he found evidence of bacteria in a stomach biopsy from a man with severe gastritis. Dr Warren was rather curious about this strange finding and a pattern began to show. Whenever their was chronic gastritis, the bacteria was present. He also noticed that the more inflammed the stomach lining was, the more abundant the bacteria.
Dr Barry Marshall
In 1981, Barry Marshall, who was in his second year of internal medicine, joined Dr Warren, in his investigation into the gastric spiral bacteria. Marshall’s interest was soon aroused as one of the patients was a woman he had seen on his ward who had severe stomach pain but no diagnosis. She had been referred to a psychiatrist and given antidepressents, for want of a better treatment. But she had some redness in the stomach and Warren’s bacteria was found in her stomach biopsy. Warren had approached other colleagues to join him but Marshall’s obvious advantage was that he had no pre-conceived ideas about the possibility of bacteria living in the acid-filled stomach. He did not come from a background of gastroenterology and so his knowledge to that date was based on science rather than dogma which seems to be a requirement to learn specialist medicine.
Attempts at culturing H. pylori
In April of 1982, Warren and Marshall had attempted to culture samples from 30 patients but without success. During the Easter holidays, the hospital was fighting an outbreak of Staphylococcus aureus and the latest culture attempt was left in the uncubator over the holidays. It was normal procedure to leave the cultures to incubate for just two days, after which, if no growth was evident the cultures were discarded. When the staff came back after the holiday, they were surprised to find that the cultures were showing growth. It was then apparent that this spiral bacteria was a slow grower. For the previous 6 months, lab technicians were throwing away viable cultures after 2 days, which is the normal amount of time a culture is left to grow. It just shows how paradigms and habits can sometimes keep research blinkered.
Their research rejected
In July 1982, Marshall moved to Port Hedland Hospital, a position allocated to him within his training. Marshall used this time to do an extensive literature search and write up all the work they had done thus far ready for presentation. Warren and Marshall presented their findings to the College of Physicians at RPH in October 1982 but their work was not very well received. There was much skepticism and many objections one of which was the link between gastritis and duodenal ulcers. It was common knowledge that gastritis was associated with gastric ulcers but not duodenal ulcers. Marshall did some more research and found that there had already been evidence way back in the 1950’s done by the Mayo Clinic. Post- mortems were carried out on vehicle fatalities or partial gastrectomy patients looking for the evidence of gastritis and ulcers. Those who had duodenal ulcers (N = 250) were all found to also have gastritis. This evidence way back in the 1950’s supported Warren and Marshall’s study but still the ulcer research fraternity ignored this relationship between gastritis and duodenal ulcers. Marshall speculated that their work was dismissed because it did not fit in with current beliefs and paradigms.
Marshall goes to Fremantle Hospital
Marshall was then offered a position at Fremantle Hospital as a senior registrar with funding to continue the research. The smallest of teaching hospitals in Perth, Fremantle had a tradition of experimentation and open-mindedness and Marshall took up the offer. The only downside was that he was forced to finish his collaboration with Warren. Even so, Marshall was surrounded by an enthusiastic group of helpers at Fremantle with the pathologist Ross Glancy joining the team.
The Bismuth Test
It was here that Marshall found out why ‘colloidal bismuth subcitrate’ (CBS) reduced the relapse rate of ulcers. He summised that CBS should have anti-microbial properties and he proceeded to test it. He soaked a filter paper disc in CBS and placed it in the middle of a Petri dish inoculated with H. pylori. After a few days and to his delight, there was a clear zone of inhibition around the paper disc.
In 1983 a Dr Martin Skirrow arranged for a presentation to be made to the European Campylobacter Meeting in September 1983. Marshall visited Dr Martin Skirrow in Worcester England. Dr Skirrow’s registrar successfully isolated the bacteria 3 days later. This proved that the spiral organism was in fact worldwide and not just a product of Australia. Further proof came from several groups around the world who were also obtaining similar results. The European group came about from the campylobacter group Marshall had met in Brussels in 1983 and they were now a close knit community sharing and writing remarkable accounts of the research which was to change the lives of millions of gastritis and ulcer sufferers.
Research still not accepted
1984 was a difficult year for Marshall. Most of his work was rejected for publication and the research was met with constant criticism. Marshall was disbelieved and the work was disputed, mainly on the premise that it simply could not possibly be true. Everyone knew nothing could live in the acid stomach, it was written in the text books! This was despite the fact that patients were being treated and cured with a disease that many had suffered for years. For the treatment to be recognised and accepted within the medical community, Marshall had to come up with something.
Out of desperation and frustration, he came up with the idea of infecting himself. His research had shown that H. pylori was sensitive to antibiotics and he himself had successfully treated gastritis patients using antibiotics and bismuth. He isolated the culture he was to drink, from a patient with active gastritis and found that the antibiotic metronidazole was effective in irradicating the cultured bacteria. The patient was then given a 2 week treatment of bismuth and metronidazole and was cured of the disease. Marshall took an anti-acid drug known as cimetidine (Tagamet) for one month* before drinking the 3 day culture. Seven days later he became very ill and began to vomit. An endoscopic biopsy of his stomach showed, much to his relief and obvious satisfaction, that he indeed had gastritis with the presence of Helicobater pylori. Marshall began antibiotic treatment a few days later and his symptoms soon disappeared. Another endoscopy proved all traces of Helicobater pylori had gone. This was irrefutable evidence linking Helicobater pylori infection of a normal stomach to gastric inflammation.
Marshall returns to the Royal Perth
At the end of 1984 Marshall moved back to Royal Perth Hospital to conduct a double blind trial for antibiotics to see if they could cure duodenal ulcers. The Australian Medical Research Council was to fund the trail on the condition Marshall could enlist a large number of patients. He would be working with Robin Warren again along with other colleagues. He and Warren still kept in touch and discussed the papers they were writing for The Lancet. They would often meet for dinner with their wives. Marshall was anxious to share the news about his self experimentation and Warren was equally excited. Now they had first hand confirmation of infection and documented results.
Warren loses his temper
At 5 am the next morning, Warren received a phone call from the USA. It was an inconsiderate journalist asking the usual stupid questions about the bacteria being just a harmless commensal and not a pathogen at all. Warren irritated, blurted out that they knew it was a pathogen because Barry Marshall had just infected himself and ‘damn near died’. The unreleased work was now in the hands of a journalist from the ‘Star’ tabloid newspaper. Freakish, bizarre and somewhat far-fetched copy was their speciality and this story was just up their street. The next day the ‘Star’ published “Guinea-pig doctor discovers new cure for ulcers…and the cause”.
As it happens, this unwanted publicity was to change Marshall’s life for the good and it was thanks to Warren’s temper. A continuous stream of patients from the USA had read the story and were desperate for the new treatment. Marshall was able to help these patients by proxy in the USA as early as 1984. This documented story and the subsequent records from the treated patients was also important when another medic tried to claim credit for being the first discoverer. Marshall was able to prove his claim to be the first along with Warren.
Dogma kept patients in misery for years.
It wasn’t until 1994 and after many years of research that the medical community started to come around to the theory of bacterial infection and the consequence of ulcers. The medical profession had thought that peptic ulcer disease was caused by too much stomach acid and this fact was laid down in medical textbooks. Because of dogma, many long suffering patients tolerated untold misery and unpleasant surgery. Once a patient had an ulcer it was difficult to erradicate and most kept their ulcers for life, controlling their flare-ups with drugs.
Intransigent medical community capitulate
How lucky it was that these two researchers were as tenacious as they were, with one resorting to putting their own life at risk to prove something that had already been proven but not recognised or accepted by the medical fraternity. Unnecessary years of suffering had to be endured because of the pig-headedness of the medical community. Warren first was suspicious of this bacteria way back in 1979. If the medical community had only taken notice and started listening and upping the research then, all those years of suffering and misery and death for so many patients, could have been avoided.
Marshall and Warren’s nobel prize speeches
In Barry Marshall’s nobel prize speech he mentioned that Warren’s wife had indicated in 1982 that there may be a nobel prize in the offing for this research. Marshall cynically replied that if so, it wouldn’t happen for ages, perhaps 1986. Dr Robin Warren and Dr Barry Marshall were jointly awarded the Nobel Prize for their research in 2005!! If anyone’s interested here’s a link to their nobel prize speeches: http://www.nobelprize.org/mediaplayer/index.php?id=614 http://www.nobelprize.org/mediaplayer/index.php?id=616
Why still PPIs?
Out of curiosity, I had a little look around for the now known treatment of gastritis and/or ulcers. We already know that Marshall was treating and curing patients with ulcers way back in 1984. As Marshall himself writes: “I was successfully experimentally treating patients who had suffered with life threatening ulcer disease for years. Some of my patients had postponed surgery which became unnecessary after a simple 2 week course of antibiotics and bismuth”.
So why is it that patients with ulcers now, are still being treated with proton pump inhibitors such as Tagamet (cimetidine). Why is the medical profession not using just antibiotics and bismuth as Marshall did way back in 1984? Could it be something to do with still pushing cimetidine and other money spinning PPI drugs?
* Marshall took an anti-acid drug known as cimetidine (Tagamet), a proton pump inhibitor, for one month before drinking the H. pylori culture. Why? To stop his stomach from producing acid which would allow the bacteria to take hold. This proves that taking these drugs seriously impairs your capacity to digest and absorb nutrients because of induced low stomach acidity. It also suggests that low stomach acid, not excess acid, is the main cause of digestive problems! See my previous post at http://magnesiumandhealth.com/proton-pump-inhibitors-side-effects/