In the last couple of years, I have developed a renewed awe and appreciation of our scientists around the world who work for entire careers to advance science and medicine in their laboratories and beyond. One such scientist is Dr. Barry Marshall.
Marshall is an Australian physician scientist, who in the early 1980s along with his cohort Dr. Robin Warren, initiated a paradigm shift in the world’s understanding of gastrointestinal disease when they discovered the bacterium Helicobacter pylori.
Prior to that, peptic ulcer disease was thought to be due entirely to lifestyle factors and stress. Marshall and Warren were ultimately able to show that H. pylori played a major role in maybe 80 percent of ulcers worldwide at that time.
H. pylori is an unusual bacterium in that it can grow and thrive in a highly acidic environment like the stomach, and for that reason, it was difficult to grow in culture. It was found to be widespread around the world, partly due to poor water sanitation systems.
The bacteria can invade the surface of the stomach and duodenum, causing inflammation of the stomach or gastritis, ulcers and, rarely, stomach cancer. We now know that if H. pylori is a causative factor in a patient’s stomach ulcers, eradication of the bacteria is an essential part of curing the patient’s disease.
Now here is the greatest piece of this science story. At the time Marshall and Warren made their discovery, the worldwide scientific community was skeptical that H. pylori was an important factor in peptic ulcer disease. H. pylori did not grow in mouse or rat stomachs, so there was not a good way to study it in a traditional lab.
Famously, in 1984 Marshall underwent a biopsy of his own stomach, proving he did not carry the bacteria nor have any stomach disease. Then, he drank a beaker of H. pylori culture broth. What followed was an acute gastric illness, and after 2 weeks he had another biopsy showing proven H. pylori infection and gastritis. He then cured himself with an antibiotic and bismuth.
After Marshall’s case study was published, much further research ensued.
Today, we can detect H. pylori in our patients with several noninvasive testing strategies, and if detected treat them with a combination of antibiotics and acid reducing medication. Surgery to remove a portion of the ulcerated stomach, commonplace prior to this discovery, is now incredibly rare in the developed world. In 2005, Marshall and Warren were awarded the Nobel Prize in Physiology for their detective work.
I wonder, had Dr. Marshall not risked his own health for his experiment, would our understanding have shifted so quickly? Maybe, maybe not, but the story sure wouldn’t be as captivating.
Kelly Evans-Hullinger, M.D. is part of The Prairie Doc team of physicians and currently practices internal medicine in Brookings, South Dakota.