Barry Marshall :a physician believing in bacterial stomach ulcers

BARRY MARSHALL (1951) THE PHYSICIAN WHO BELIEVED, AGAINST AA OTHERS, IN INFECTIOUS GASTRIC ULCERS

André J. Fabre                               October 2012

 Barry Marshall was in charge of the Laboratory of Microbiology at the Royal Hospital of Perth in Australia when he had the idea, together with his colleague pathologist Robin Warren that gastric ulcers could be linked to bacteria. 

A CAVAMCADE  OF ETIOLOGICAL HYPOTHESES [1]

For two centuries, a flowering of hypotheses tried to explain the genesis of peptic ulcers

In 1771, Marie François Xavier Bichat thought he had found the cause of the problem when he observed the appearance of inflamed areas in the pyloric mucosa of ulcer. Around the same time, Frederik Johann Meckel suggested that gastric ulcers could be damage from gastric juices action.

An English physician, James Crampton stressed the similarity of gastric lesions observed in many acute poisoning with ulcers disease.

Thereafter, came theories about the role of alimentation in diet and later on, the idea of an organic response to psychological disturbances. Everything was summed up in a single word from  Anglo-Saxon vocabulary: the "stress". Some searchers did not hesitate, from that, to treat gastric ulcers with  neuroleptic drug such as sulpitride.

In the fifties, appeared a new theory on the possibility  of excessive acid secretion in stomach, thus justifying intravenous injections of Laristine associated with antimuscarinic medications and various gastric dressings.

Then came the era of the "anti H2", substances designed to bind to histamine receptors, like a false key blocking a keyhole : the first trial of such medications used cimetidine and its results were considered miraculous until 1974 when  appeared prostaglandins, as Emprostil, proposed as "anti secretory medication."

Finally, in the 1980s arrived the use of inhibitors of the "proton pump", the lost famous being Omeprazole, a drug designed to block the secretion of hydrochloric acid in the gastric mucosa.

As a last resort, in the most severe cases, remained surgery performing a  partial or even total gastrectomy.

 A BUG IN THE STOMACH?

It was in 1982 that came from Australia, the most unexpected explanation of the genesis of gastric ulcers : a bacteriologist, Barry Marshall, Professor of Clinical Microbiology at the Perth Hospital in collaboration with the hospital pathologist Robin Warren, had identified a bacteria of helical structure in the gastric epithelium of ulcer patients [2]. A name was gven to the bug : Helicobacter pylori

In retrospect, this explained why therapy with bismuth nitrate was efficien in such cases : there was no real protective effect on the gastric mucosa, but a direct antiseptic action on the causative bacteria.

The medical community all around the world was so much convinced that no bacteria could survive in highly  acid fluids, and stomach juices were a typical example,  that a "common front" was raised to bar all specuations based on Marshall and Waren works.

Finally, Barry Marshall had to perform on himself a crucial experience, as nobody ever attempted before : swallowing a whole broth of Helicobacter pylori culture. The result was decisive: in less than a week appeared a gastric ulcer which had to be treated  with massive doses of antibiotics.

 THE NOBEL PRIZE AS REWARD FOR ALL VEXATIONS

Marshall and Warren received the 2005 Nobel Prize in Physiology and Medicine. As said the homage given on this occasion: "In contrast to existing dogmas, you discovered that one of the most prevalent diseases and the most important of humanity, ulcer peptic, is caused by a bacterial infection of the stomach. Through your discovery, this often chronic and disabling disorder can now be permanently cured with antibiotics for the benefit of millions of patients. Your pioneering work has also encouraged researchers world whole to better understand the link between chronic infections and diseases such as cancer. "

 THE TRUTH OF TRUTHS

Once again, the history of the great discoveries in medicine had given us a great lesson in relativity courses but but one question still  remains: when will the next "truth" of gastric ulcers?

Should we believe in Pablo Neruda, who had announced in one of his books: "The real truth is that there is no truth" [3] ...

 

 a.fabre.fl@gmail.com________________________________________

[1] This fascinating episode in the history of medicine is well explained in the book by Roger Teyssou, history of peptic ulcer - The why and the how, Paris, L'Harmattan, 2009

[2] Marshall BJ, Warren JR. Unidentified curved bacillus on gastric epithelium in active chronic gastritis. Lancet 1 (8336) :1273-1275, 1983.

[3] And why not see the symbol of science in the famous earrings repeating ad infinitum the same imge, never, however, quite the same

 

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