Infectious Ulcers Win Nobel Prize

For decades medical students were taught a simple rule: “no acid, no ulcer.” It was an article of faith that stress and an executive life style contributed to acid-induced stomach ulcers.
Millions of ulcer patients were advised to eat a bland diet and take antacids like Maalox or Mylanta. Although these recommendations were standard, they weren’t very effective.
When strong acid-suppressing drugs like Tagamet, Zantac and Pepcid came along, they were hailed as a huge advance in ulcer therapy. Although such medicines reduced acid in the stomach, ulcers and stomach irritation often returned when the medicine was discontinued.
In 1982, Australian gastroenterologist Barry Marshall, MD, and his colleague, pathologist Robin Warren, MD, developed a completely new theory about the cause of stomach ulcers. These Australian researchers had data linking a bacterial infection (Helicobacter pylori) to the development of gastritis and ulcers.
In other words, ulcers could be “caught” like other infectious diseases and were not the result of bad diet or a high-pressure lifestyle. To cure them, a person needed antibiotic treatment, not just acid suppression.
Despite the evidence, physicians were reluctant to accept this radical concept. Fighting acid was so ingrained in ulcer treatment that antibiotics seemed irrational.
It took years before the medical establishment accepted the idea that ulcers could be caused by infection. This month, Drs. Marshall and Warren were awarded the highest honor a researcher can receive: the Nobel Prize in medicine.
Although this recognition vindicates their work, many doctors still rely on acid-suppressing drugs like Prilosec, Prevacid and Nexium to treat gastritis and stomach ulcers. Antibiotics to eradicate H. pylori are prescribed far less frequently.
According to Marshall, this bug may lie behind some cases of hard-to-treat bad breath. Antibiotic therapy to eradicate the infection sometimes cures the bad breath. Other research has linked Helicobacter infections to even more serious conditions, such as stomach cancer or heart rhythm abnormalities.
To learn more about Helicobacter and its treatment, you may wish to read our Guide to Digestive Disorders.
If someone is infected with H. pylori, taking acid-suppressing drugs like Zantac, Tagamet or Prevacid won’t cure the infection. Some experts maintain that suppressing stomach acid without eliminating the bacteria might even increase a person’s risk of developing “atrophic gastritis,” a condition that appears to be a precursor for stomach cancer. This issue remains quite controversial.
One lesson to be taken from the Helicobacter-ulcer story is that infection and resulting inflammation might lie behind other chronic conditions. Scientists are looking for the agents that might trigger type-1 diabetes, inflammatory bowel disease or even arthritis. If this line of research proves fruitful, it could be another consequence of the creative thinking of Warren and Marshall.