Peptic Ulcers and Bacteria 1984 – Helicobacter Pylori

In 1586, physician Marcellus Donatus of Mantua, Italy, was one of the first to document open sores in the stomach lining during an  autopsy. 

Until recently, peptic ulcers in the stomach and adjacent duodenum (the first part of the small intestine) were thought to result from stress and diet. Today, we know that the vast majority of these ulcers are caused by the spiral-shaped bacterium  Helicobacter pylori, which thrives in the stomach's acidic environment. 

Medical acceptance of the bacterial cause resulted from the pioneering efforts of Australian researchers Robin Warren and Barry Marshall. In 1984, to help convince his sceptical colleagues, Marshall drank the contents of a Petri dish containing H. pylori and developed gastritis  (inflammation of the stomach lining)  five days later.

• Ulcers can cause abdominal pain and vomiting of blood. 
• Perforation of the stomach or duodenum can be life-threatening. 
• When H. pylori colonises the stomach, it can increase or decrease the release of gastrin, which controls the amount of stomach acid, and can cause chronic inflammation. 

H. pylori can be detected using cultures taken from the stomach or duodenum, blood tests (for antibodies), stool tests (for antigens) and the urea breath test. In the urea breath test, the patient takes radioactive urea, and the presence of H. pylori is detected if radioactive carbon dioxide is found in their breath.

H. pylori is thought to spread through food, water and human saliva. However, only some people carrying H. pylori actually develop ulcers. This may relate to genetic susceptibility and the differing harmful effects of H. pylori.

Treatment for H. pylori  involves a combination of antibiotics, bismuth compounds and proton pump inhibitors that reduce stomach acidity. Interestingly, in 1958, Greek physician John Lykoudis developed his own antibiotic treatment for ulcers, but his work was largely dismissed by other doctors.

Peptic ulcers can also be caused by  aspirin, ibuprofen and other NSAIDs (non-steroidal anti-inflammatory drugs). NSAIDs can reduce the production of prostaglandins (hormone-like molecules), which normally stimulate the production of protective mucus in the stomach.

Description of the article image: An artistic representation of H. pylori with four to six flagella (whip-like tails) that enable the bacterium to pass through the mucus lining and reach the stomach epithelium.

Historical figures mentioned in the article: Marcellus Donatus of Mantua (1538–1602), John Lykoudis (1910– 1980), John Robin Warren (b. 1937), Barry James Marshall (b. 1951)

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