On the day that John Robin Warren, an Australian pathologist and researcher, turned 42, exactly June 11, 1979, he observed under a microscope a blue line in a stomach sample in a biopsy taken from a patient with chronic gastritis.
Curiosity led him to increase the magnification of the lenses to observe this detail more closely and His surprise was greater when he discovered that said line was actually a collection of bacilli (curved bacteria) strongly attached to the surface of the tissues.
With this anecdote, José María Pajares-Garcia and J. P. Gisbert in an article published in the Spanish Journal of Digestive Diseases, They marked the beginning of the discovery of the bacterium that fundamentally changed the history of the most common and dangerous stomach diseases: Helicobacter pylori.
In their story, they add that for scientific reasons, Warren – trained at the University of Adelaide – for more than a year and a half set about the task of compiling similar cases in which these bacteria accompany, in particular, stomach tissues. inflamed, i.e. to gastrin. Of course, as a pathologist, I knew that when bacteria were present in places in the body where there was inflammation, they had to be considered the primary cause of the inflammation. But here things were different because it was also – until then – assumed that bacteria could not survive, much less grow and multiply in the environment of natural stomach acids.
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And in this context, although Warren had in his hands the evidence that something unusual was happening, to the extent that what he observed completely changed the paradigms of the survival of microorganisms in a hostile environment, no one believed him except Winn – his wife -, a psychiatrist, who eventually became his main cheerleader.
The role of his partner was so important that Warren later said in an interview “I admire my wife and thank her for the moral support because as a mother of 5 children and having every reason to be upset, her husband spent his time and money looking for non-existent bacteria”, although he also admitted that his wife had all the elements to refer him to his fellow psychiatrists.
His stubbornness led him to try all available stains to identify the bacteria, until he was unable to stain these micro-organisms so clearly that they could be distinguished from the human cells in which they were disguised, until finally a colleague of his, Len Matz, He accepted the finding and encouraged him to continue collecting information with more patients and joined the cause, which led to the conclusion – with little effort – that these bacilli are present in all forms of gastritis, including chronic gastritis.
By 1981, Warren had become a solitary defender of his findings, and it was at this time that he was visited by Dr. Barry Marshall, a colleague of his at the Royal Australian College of Physicians, who, as part of his training, had to do research work, so that his boss offered him to join the work of “mad Warren” who was trying to “turn gastritis into an infectious disease”.
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Skeptical, Marshall, 31, began taking biopsies from normal stomachs and was delighted when found that such bacteria did not appear in gastric mucosa that did not have inflammation and he therefore became passionate about this research, so much so that he contacted the most important microbiologists in his country with a view to finding the technique to be able to cultivate the “new bacteria” discovered by Warren.
Since this bacillus was similar to the already known, campylobacter, they began to take it as a basis to create the conditions under which the newly known bacillus could be incubated, something that was not without disappointment, until several months later – about the vacation in the corner – a laboratory assistant found that one of the biopsy cultures left in one of the heated cabinets showed clear bacterial colonies that, when placed under a microscope, were similar to those found by Warren in the so-called blue lines of their tissues.
antibiotics for inflammation
Before the end of 1981, and still not able to be effectively cultured, but already with the theoretical basis that the bacterium caused inflammation of the stomach, a patient of Russian origin who suffered from severe gastritis, which indicated the presence of the disease, was treated with antibiotics. , until then campylobacter.
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Treatment with tetracycline – which was the recommended antibiotic for Campylobacter – for 14 days ended up eliminating the abdominal pain and other symptoms, although it was acknowledged that this therapy had no clear scientific support. However, when a follow-up endoscopy is performed, it was noticed that the inflammation of the stomach decreased and the bacteria disappeared.
After many tests that gave more scientific solidity, Warren and Marshall designed a clinical study that produced results that, after overcoming the skepticism of the editors, were accepted by the journal “The Lancet”, which in turn accompanied the article in a laudatory editorial note. emphasizing the originality and importance of the discovery.
In 1989, the scientific community changed its name to Warren’s bacterium, and it has since been known as Helicobacter pylori.
Curiously, the need to test things in practice led Marshall to decide to infect himself with the bacteria after making sure his stomach was normal; when he developed biopsy-confirmed gastritis, he began his treatment with bismuth salts and metronidazole for 14 days, which the discomfort disappeared and an endoscopy after a month showed the disappearance of the inflammation.
With this data, microbiologists undertook to study the bacterium in depth and were able to show that Campylobacter was not actually Campylobacter and that it rather contained structures of a new genus: Helicobacter.
In 1989, the scientific community renamed Warren’s bacterium and it has since been known as Helicobacter pylori. But the matter did not stop there, because although this bacterium is directly related to gastritis and ulcer, its relation to the development of gastric carcinoma was not delayed when it was demonstrated by very rigorous epidemiological studies, to such an extent that in 1994 the International Agency for Research on Cancer (IARC), an organization subordinate to the World Health Organization (WHO), included Helicobacter pylori in Group 1, a definitive carcinogen.
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All this evolution has made it possible to prove the connection between Helicobacter pylori infection, gastritis, duodenal and gastric ulcers, carcinoma and gastric lymphoma, to such an extent that new diagnostic and therapeutic tools have been developed, which, as they develop, save many lives.
Today there are defined protocols and a clear need to destroy the bacteria from the stomach if found, to avoid complications that can end up with the tumor, which causes more mortality among men and women.
Nobel for this story
In 2005, the jury of the Karolinska Institute in Stockholm, responsible for awarding the Nobel Prize in Medicine, highlighted the tenacity of Warren and Marshall when they questioned the established dogmas surrounding gastritis, gastric and duodenal ulcers and stomach cancer and awarded them, which no one asked.
The bacterium and its effects
Helicobacter pylori is present in 50 percent of all people and there is no region of the planet that is free from its presence. According to Angel Alberto Castro, a gastroenterologist at the National University, it is transmitted from one person to another through direct contact with saliva, vomit or contaminated items, as well as through food or water in which it is present.
According to the specialist, this microorganism has a particular affinity for stomach tissues, where it adapts and multiplies despite the acidic environment, causing inflammation that can later turn into an ulcer in some people.
The presence of Helicobacter in the stomach can be complicated because, in addition to causing swelling and irritation in these tissues (gastritis
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Castro insists that people are infected from childhood and the risk factors are related to living conditions such as overcrowding, lack of reliable sources of clean water, poverty and lack of sanitation services and of course sharing with people who have the infection.
Having Helicobacter in the stomach can be complicated because, in addition to causing swelling and irritation in these tissues (gastritis), it also damages the protective lining of the stomach and the first part of the intestine (duodenum), allowing acids to damage tissues and produce sores (ulcers), which occur in 1 in 10 people infected with Helicobacter.
Similarly, Infection with this microorganism has been shown to be an important risk factor for certain types of stomach cancer.
If its presence is detected, a very strict antibiotic treatment should be started, which in most cases requires combined therapies.
Gastroenterologist Castro adds that most people with Helicobacter pylori have no symptoms, but when they do, it can be in the form of pain, burning in the upper abdomen that can get worse when the stomach is empty, and there can be nausea , loss of appetite, gas accumulation and even weight loss.
Although the above manifestations require a doctor’s judgment, it should be urgent if the stomach pain is constant, even at night, have bloody or black stools, as well as bloody or dark brown vomit.
Of course, in case of doubt, an endoscopy with biopsies of the damaged areas should be done to characterize the type of injury and, of course, specific tests should be done to establish the presence of Helicobacter pylori.
Castro says that if its presence is confirmed, a very strict antibiotic treatment should be started, which in most cases requires combination therapies for a certain time with medical follow-up to determine the evolution.
And what about cancer?
Helicobacter pylori is a bacterium that in the stomach can cause gastritis, ulcers, and in some cases (approximately 1 percent of infections) stomach cancer.
The majority of stomach cancers are caused by H. pylori. The incidence and number of new cases of stomach cancer have decreased in many areas of Europe, but high-risk areas remain, particularly in Eastern Europe and parts of Spain, Portugal and Italy.
Source: Helicobacter pylori, its discovery and importance in medicine. Spanish Journal of Digestive Diseases (JM Pajares and JP Gisber).
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