The Guts of the Matter
Everybody knew the facts about ulcers. Caffeine could trigger an attack.
Spicy food should be shunned. Stress had to be avoided at all cost. People
with ulcers were resigned to consuming bland food and Malox.
That was until 1983 when Barry
Marshall and Robin Warren, two physicians from Perth in Western Australia,
published a theory so fantastic that it drew scorn from colleagues. They
said that diet and stress weren't responsible. They proved that the cause
of most ulcers was a bacterium called Helicobacter pylori that lurks
in the stomach lining of most patients with gastritis and ulcers.
Strands of H. pylori under an electron microscope.
The inside of the stomach is a veritable pit of gastric juice composed
of enzymes and hydrochloric acid that can eat through most anything. That's
why a thick lining of mucus layers and protects the stomach lining. And
it is there that Helicobacter pylori hide.
This bacteria is common. Estimates are that 50 percent of people over
age 50 in the United States are infected, according to the Helicobacter
Pylori Foundation. Although the infection may be present, only 10 to
15 percent of those infected go on to have an ulcer. However, 60 percent
to 80 percent of people with gastric ulcers and 90 percent of those with
duodenal ulcers have the bacterium, according to Medicine
Professor David Kearney, who specializes in gastroenterology
at the UW.
Kearney and colleagues see patients at a specialized Helicobacter
pylori clinic at the Veterans Administration Puget Sound Health Care
System in Seattle and Tacoma.
For those who suffer from ulcers, he recommends treatment with a proton
pump inhibitor (drugs such as cholriythromiocin and oxoxymicin metronidazole)
in combination with two antibiotics. The inhibitor reduces the production
of acid and the antibiotics attack the bacteria. Kearney said that this
regimen dramatically lowers the recurrence rate of ulcers.
"Previously, up to 70 percent of people with duodenal or gastric
ulcers would have a recurrence within a year. This lowers the rate to less
than 10 percent," he says.
Formerly, doctors would use an endoscopy to detect an ulcer. That meant
sedation, an IV, and looking into the stomach with a tube. Now, there's
a simple breath test that can detect the presence of the bacterium. The
test can't confirm that there is an ulcer, but if a patient comes in symptoms
of ulcer and the Helicobacter pylori is present, it may be likely
that the antibiotics in combination with an acid reducer can solve the problem.
Just as ulcer patients lives have changed, so have the lives of Barry
Marshall and Robin Warren. The pair have won the Warren Alpert Prize from
the Harvard Medical School and Germany's Paul Ehrlich Prize. Marshall won
the prestigious Albert Lasker Award in 1995 and both men have been mentioned
as possible Nobel Prize winners. As an Australian colleague told the press,
"It is one of the major breakthroughs in this century. They both should
get it."--Julie Garner