What's so interesting about the award of the Nobel prize to these two Australian scientists, Robin Warren and Barry Marshall, is that when in the early 1980s they suggested that the underlying cause of the excessive acid secretion that causes peptic ulcers was a chronic infection, they were met with derision.

A presentation at an international conference by Dr Marshall was even greeted with laughter. His audience told him the bacteria must have contaminated the stomach samples after the stomach tissues had been removed. Or maybe the bacteria were harmless and unrelated to the ulcers. Or maybe the bacteria were able to colonize the stomach as a result of the ulcer.

Marshall compared the scientists' plight to being in a small boat signalling desperately to people on a large ocean-going liner that they're headed in completely the wrong direction. In fact, the liner heading away from Barry Marshal was not just a large one - it was extremely luxurious.

Oversecretion of stomach acid was generally believed to occur in people with overanxious, frustrated personalities. The standard treatment was a bland diet, tranquilizers, psychotherapy, sometimes surgery, but mainly the prescription of lots and lots of antacids. People with ulcers had to take the $100-a-month antacids almost continuously.

The standard treatment of ulcers had turned antacids into the biggest-selling prescription drugs in the world, so the Australian scientists* discovery, if accepted, was extremly bad news for the companies selling them. It stood to deprive some of the world's largest corporations of billions of dollars in revenue. If ulcers were caused by the bacterium Helicobacter pylori, a simple two-week course of antibiotics might permanently cure millions of people.

It took a decade of dogged determination for the two scientists to begin to persaude others that Helicobacter was at the root of a range of diseases, including gastric and duodenal ulcers and stomach cancer, and that its eradication produced dramatic results. Marshall had to resort to some startling tactics along the way, including drinking a solution of the bacterium, thus producing inflammation of his own stomach - confirmed by gastroscopy - and then successfully treating it.

But a decade after Warren and Marshall's discovery, Americans were still buying $4.4 billion worth of antacids, though by then the drug companies were hastily developing new diagnostic tests for H. pylori as well as new antibiotics to treat the infection. Biotechnology companies, meanwhile, were trying to develop a vaccine, to be given in childhood. Even by 1996, however, two-thirds of doctors were still prescribing antacids for their ulcer patients.

Another decade on and Warren and Marshall have been awarded the Nobel prize, while Lord May, the President of the Royal Society, bestows his blessing upon the two "mavericks" (see below).

The article below also notes that the Nobel citation praises the doctors for their tenacity, and willingness to challenge prevailing dogmas.
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Nobel for stomach ulcer discovery
http://news.bbc.co.uk/1/hi/health/4304290.stm

Two Australian scientists have been awarded the Nobel prize for medicine for their discovery that stomach ulcers can be caused by a bacterial infection.

Robin Warren and Barry Marshall showed the bacterium Helicobacter pylori plays a key role in the development of both stomach and intestinal ulcers.

Thanks to their work these ulcers are often no longer a long-term, frequently disabling problem.

They can now be cured with a short-term course of drugs and antibiotics.

In 1982, when H. pylori was discovered by Dr Marshall and Dr Warren, stress and lifestyle were considered the major causes of stomach and intestinal ulcers.

It is now firmly established that the bacterium causes more than 90% of duodenal (intestinal) ulcers and up to 80% of gastric (stomach) ulcers.

Dr Warren, a pathologist from Perth, paved the way for the breakthrough when he discovered that small curved bacteria colonised the lower part of the stomach in about 50% of patients from which biopsies had been taken.

Key observation

He also made the crucial observation that signs of inflammation were always present in the stomach lining close to where the bacteria were seen.

Dr Marshall became interested in the findings and together they initiated a study of biopsies from 100 patients.

After several attempts, Dr Marshall succeeded in cultivating a hitherto unknown bacterial species - H. pylori - from several of these biopsies.

Together they found that the organism was present in almost all patients with gastric inflammation, duodenal ulcer or gastric ulcer.

Even though stomach ulcers could be healed by inhibiting gastric acid production, they frequently relapsed, since bacteria and chronic inflammation of the stomach remained.

Dr Marshall and Dr Warren showed patients could only be properly cured when H. pylori was eradicated from the stomach.

Infected himself

Dr Marshall proved that H. pylori caused gastic inflammation by deliberately infecting himself with the bacterium.

The Nobel citation praises the doctors for their tenacity, and willingness to challenge prevailing dogmas.

"By using technologies generally available they made an irrefutable case that the bacterium H. pylori is causing disease.

"By culturing the bacteria they made them amenable to scientific study."

It is thought that H. pylori infection can trigger an ulcer by stimulating increased acid production in the stomach, leading to damage to the stomach or intestinal lining.

Lord May of Oxford, President of the Royal Society, said: "The work by Barry Marshall and Robin Warren produced one of the most radical and important changes in the last 50 years in the perception of a medical condition.

"Their results led to the recognition that gastric disorders are infectious diseases, and overturned the previous view that they were physiological illnesses."

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