HELICOBACTER

In 1983, a pair of Australian microbiologists suggested that gastritis and peptic ulcers
were infectious diseases, contradicting long-held beliefs concerning their epidemiology,
pathogenesis, and treatment. In the same year, the 10th edition of Harrison’s Principles
of Internal Medicine described peptic ulcers as due to an unfavorable balance between
gastric acid–pepsin secretion and gastric or duodenal mucosal resistance. Underlying
causes cited included genetic and lifestyle (smoking) as well as psychological factors
(anxiety, stress). Treatment with bismuth salts, antacids, and inhibitors of acid secretion
gave relief but not cure. Relapsing patients (50 to 80%) were subjected to surgical treatments
(vagotomy, partial gastrectomy), which had their own set of complications (reflux,
afferent loop syndrome, dumping syndrome). All of this was logical and supported by
clinical observations and research studies. It was simply incorrect. The bacteria now
called Helicobacter had been observed but dismissed because they were so common and
its urease was once considered a secretory product of the stomach itself. The paper by
Warren and Marshall (see Additional Reading) stimulated the reversal, which has led to