Nobel Prize in Medicine Awarded to Gastroenterology Team
Jerome D. Waye, MD

The long-held belief that ulcers were caused by acid and that and eliminating acid cured them was exploded by Dr. Barry J. Marshall (of the University of Western Australia in Nedlands, Perth) and Dr. J. Robin Warren (a pathologist at the Royal Perth Hospital), who "made an irrefutable case that the bacterium Helicobacter pylori" causes ulcers and other diseases (quoted from the citation by the Nobel Committee from the Karolinska Institute in Stockholm). The citation goes on to state that "it is now firmly established that Helicobacter pylori causes more than 90% of duodenal ulcers and up to 80% of gastric ulcers." The discovery of this basic phenomenon that intestinal ulcers are caused by an infection has forever changed the way gastroenterologists approach the ulcer problem.

Warren's first case of H. pylori, 1979.

Barry Marshall and Robin Warren, 1984.

In the early 1980s, Dr. Warren noted the spiral-shaped bacterium in the lower part of the stomach in about half of the patients who had biopsies. He made the observation that inflammation was always present in the gastric mucosa when the bacterium was present. Dr. Marshall joined Dr. Warren in studying this hitherto unknown bacterium, which they originally thought was one from the Campylobacter family, and named it C. pyloridis after Dr. Marshall succeeded in culturing it. It was later found that it was a member of the Helicobacter family, and it was renamed H. pylori.

Dr. Marshall conducted a classic experiment on himself that undeniably linked the bacterium to inflammation of the stomach and demonstrated that the inflammation resulted from an infectious process. When Dr. Marshall was in his early 30s, he had a colleague examine his stomach and take a series of biopsies. Ten days later, after waiting for the biopsy sites to heal, he swallowed a pure culture of H. pylori. One week later, he felt dyspeptic, full after eating, and had bad breath and general malaise. Several days later, he underwent the first of three post-ingestion gastroscopies and biopsies. The biopsies demonstrated that he had developed an acute inflammatory process in the stomach, which he successfully treated with antibiotics. When Dr. Marshall presented his first paper on his discovery of the relationship between this bacterium and gastric inflammation and ulcers, the world of gastroenterology refused to accept the findings. Gastroenterologists in general were slow to accept this report, which was so diametrically opposite to the teaching of generations of stomach experts. These two ordinary men were able to look at a finding that many had seen before, and "with tenacity and a prepared mind challenged prevailing dogmas," as the Nobel citation states.

Marshall and Warren celebrating outside their local pub in Australia, October 2005.

Both members of this team accepted their prize with modesty. Dr. Warren pointed to the ground-breaking clinical experiment that Dr. Marshall performed on himself, while Dr. Marshall states that working in an academically obscure location aided in the discovery, as he and Dr. Warren were able to pursue their observations without interference from prevailing beliefs. Dr. Marshall stated, "If I had come up through the normal gastroenterology training schemes in the United States, I would have been so indoctrinated on the acid theory that I wouldn't have been considering anything else and might have skipped over Helicobacter, as everyone else had done." He also stated that "Robin is quite obsessional. Once he sees something, he is determined to see what it is. He would have found another Barry Marshall" to work with. These two scientific researchers were awarded the Nobel Prize by the King of Sweden on 10 December 2005, the anniversary of the death of Alfred Nobel, the Swedish dynamite inventor who created the prizes in his will.

The world's gastroenterology community congratulates Dr. Barry Marshall and Dr. J. Robin Warren, on being awarded the 2005 Nobel Prize for Medicine.