Nobel Prize Awarded for Stomach Ulcer Discovery

gollum123 writes to tell us the BBC is reporting that the Nobel prize for medicine has been awarded to two Australian scientists for their work with ulcers. Their research has shown that the majority of ulcers are caused by bacteria and can be cured with a short-term course of drugs and antibiotics. From the article: "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."

1982!

[Stile 65]

The Nobel Prize committee is almost as slow as Slashdot. The actual discovery, per TFA, was made in 1982.

Inflammation

[iamplupp]

This was one of the first discovieries but today we know that inflammation is the cause, or at least plays an important role, in lots if other diseases. Heart disease, rheumatism, diabetes, etc.

Re:Now that's my kinda medicine

[Anonymous Coward]

IIRC veterinarians have known how to cure ulcers in pigs since the 30's. The treatment is Bismuth and an antibiotic. Bismuth is found in that wonderful pink stuff: Pepto-Bismol. Very simple treatment. Not some new super drug that has all sorts of nasty side effects.

Re:Now that's my kinda medicine

[AKAImBatman]

How stringent are the doctors in testing if you have an ulcer or not before handing out the drugs?

They're usually not too bad on testing for the ulcer itself. Unfortuately, they are quite happy to hand out powerful drugs for anything that appears to be gastritis.

The upshot is that the drugs they will give you (primarily antibiotics) are for short term use, and aren't that different from what they tend to give people "just in case". Though I have to wonder if some of the stomach damage isn't caused by reckless use of antibiotics. The human stomach is inteded to have a variety of bacteria to aid in digestion. Using antibiotics tends to nail ALL bacteria, including the stuff you want to keep.

Yogurt with live cultures is a good way of replacing Acidophilus, but if you've recently had antibiotics, you might want to think about a bottle of bacterial supplements. These can be had in pill form, but you *must* keep it cold and pay attention to the expiration date.

Well...

[Seoulstriker]

They are actually indeed caused by stress. When your immune system's function is severely inhibited during long-term stress, your body's ability to fight bacterial infection is weakened to the point that H. pylori can easily reside in your stomach and cause the ulcer.

So, stress is involved, albeit indirectly.

Re:willingness to challenge prevailing dogmas

[top_down]

Willingness is not the problem. Disproving evolution would make you famous and rich. The problem is the enormous amount evidence against you:

http://talkorigins.org/origins/faqs-mustread.html [talkorigins.org]

Comment removed

[account_deleted]

Comment removed based on user account deletion

Nobel Prize in Physics Awarded Also...

[warmgun]

The Nobel prize in Physics has been awarded also: http://nobelprize.org/ [nobelprize.org]

According to the schedule on the website, chemistry gets awarded tomorrow and peace on Friday.

Protects esophagus, harms stomach

[chooks]

One of the more interesting items about this bug is that while it appears to cause stomach cancer, it also seems to protect against esophageal cancer:

http://www.genomenewsnetwork.org/articles/04_03/py lori.shtml [genomenewsnetwork.org]

It also seems to have some sort of effect on reducing acid reflux. Scientific American had a great article about a year ago or so about this bug and how it works. Very interesting reading.

Diagnosis and treatment

[DarkFencer]

Fortunately, this is a very easy thing to diagnose and treat. I'd never had a problem with heartburn, but in the past several months it has become unbearable. The doctor gave me a blood test for H. Pylori, which came with very high levels of the bacteria

I'm actually currently taking a treatment for it. One of the common ones is a combination of three drugs. Two antibiotics (for me Amoxicillin and Clarithromycin), and a PPI (Proton Pump Inhibitor - like Nexium, Protonix, or a few others - I'm taking Prevacid).

The only draw back to the treatment is its a LONG 14 days of strong medicine. Makes your stomach feel horrible to say the least.

But the point is, I'd rather a couple weeks like this, then years of popping antacids. My thanks go out to these pioneers.

Re:Inflammation

[chinodelosmuertos]

Inflammation isn't really the CAUSE, per se. Peptic ulcer is due to a hypersecretion of stomach acid. H. pylori attacks the D cells in the stomach that normally turn off acid secretion in the parietal cells. It probably directly affects ECL cells (they release histamine, a potent mediator for the release of acid) and also directly stimulates the HCl producing parietal cells as well. The acid doesn't really cause inflammation, it erodes the mucous protective layer in the stomach, which can either perforate through into your abdominal cavity, penetrate your intestines and create a fistula, or erode your stomach wall causing bleeding. The only way you'd really get inflammation is if you get irritation of your abdominal cavity, but then it's not just an ulcer, it's peritonitis due to your ulcer. So the problem with the ulcer per se isn't the inflammation. It's the erosion of the gastric lining leading to perforation or penetration.

As for inflammation being involved in heart disease, rheumatoid and diabetes... Yes. Sorta. Heart disease slightly, depending on what heart disease you mean. Rheumatoid for sure. Type 1 diabetes is caused by an autoimmune attack on your pancreatic beta cells. Might cause a little inflammation but the attack is specific to the beta cells. (inflammation is a non-specific response to a foreign antigen) Type 2 diabetes... the kind fat people get.... not inflammatory at all. It's due to your peripheral body no longer responding to insulin (look up GLUT4 receptors if you want)

Hope that cleared things up.

Re:1982!

[DrHanser]

What the fuck are you on about? H. pylori is treated with a combination of two drugs at a time. Usually amoxicillin and clarithromycin (Biaxin) or Amox + metronidazole (Flagyl). These aren't new or drugs specifically designed to target H. pylori. They're broad-spectrum antibiotics used for many things.

Re:Nobel awarded on merit of utility or tenacity??

[chinodelosmuertos]

Hmm. You sorta opened a can of worms here. A couple of issues here.

First: Does H. pylori eradication lead to increased incidence of Barrett's esophagitis and esophageal cancer? Maybe. The jury is still out. The Japanese have just published a pretty comprehensive review (Japanese Journal of Clinical Medicine. 63(8):1383-6, 2005 Aug)on the subject. The increase in one may be more common with the eradication of the other. Fine. Are they casually related? That's a more complex question that I think the research is sorta investigating. I dont think Scientific American really has the answer.

But that's not the major issue. Stomach ulcer is a condition that PRIOR to the triple treatment (bismuth + antibiotics + acid inhibitors) would take months to years to heal. Some anecdotal stories as long as 6 years. More. Sometimes never. Leading to serious, serious complications that have even worse prognoses. You see what I'm getting at here. Quality of life years lost are huge, affecting huge chunks of the population. Known risk of causing stomach cancer, perforation of your guts (think your guts spilling into your abdominal cavity) and iron deficiency due to chronic bleeding just for a start. Now we're saying... OK. It MAY result in reflux, eosophageal cancer and Barrett's (cells in your eosophagus changing morphology).

Hardly the "eliminating H. pylori is worse than the symptoms created by too much of it." If anything, what this might suggest is that there might be some unwanted complications to altering the internal milieu of the stomach, and they should be addressed. Full stop. Sky's not falling yet, pal.

mitochondria

[smazzle]

It's similar to Lynn Margulis' discovery that the mitochondria were originally their own organism and have since been integrated into our cells. She first made that claim in the 1980's, and only now has it started to become accepted dogma. It takes time to change minds, and she's still working on it. http://en.wikipedia.org/wiki/Lynn_Margulis [wikipedia.org]

Re:Ouch

[reverseengineer]

From Alfred Nobel's will:

"The whole of my remaining realizable estate shall be dealt with in the following way: the capital, invested in safe securities by my executors, shall constitute a fund, the interest on which shall be annually distributed in the form of prizes to those who, during the preceding year, shall have conferred the greatest benefit on mankind. The said interest shall be divided into five equal parts, which shall be apportioned as follows: one part to the person who shall have made the most important discovery or invention within the field of physics; one part to the person who shall have made the most important chemical discovery or improvement; one part to the person who shall have made the most important discovery within the domain of physiology or medicine; one part to the person who shall have produced in the field of literature the most outstanding work in an ideal direction; and one part to the person who shall have done the most or the best work for fraternity between nations, for the abolition or reduction of standing armies and for the holding and promotion of peace congresses. The prizes for physics and chemistry shall be awarded by the Swedish Academy of Sciences; that for physiology or medical works by the Karolinska Institute in Stockholm; that for literature by the Academy in Stockholm, and that for champions of peace by a committee of five persons to be elected by the Norwegian Storting. It is my express wish that in awarding the prizes no consideration be given to the nationality of the candidates, but that the most worthy shall receive the prize, whether he be Scandinavian or not."

(Emphasis mine) Now, according to Nobel's will, it would appear that his original intention was for prizes to be given for discoveries made, works published, or actions taken in the previous year, more of an "MVP" award than a "Hall of Fame." Looking at the first few laureates in each category, however, it is clear that the prize foundation more or less ignored this idea and gave prizes for work that was relatively recent, but not necessarily from the previous year. Several of the earliest physics prizes, awarded at the turn of last century, for example, were awarded for discoveries made in the late 1890s. However, it's difficult to argue that Roentgen, the Curies, etc., were not deserving recipients. And delaying the prize for a few years is basically necessary if you want to award it for theoretical research of any sort- Albert Einstein won a Physics Nobel in 1921 for work he did in 1905- the committee wouldn't want to give it to him in 1906 and then find out in 1907 that his paper explaining the photoelectric effect was deeply flawed.

For some of the other prizes, the award has been used to honor both recent and lifetime achievement. The literature prize, for example, has been given both for an outstanding career of work and largely on the strength of a single work. The peace prize is probably the one most often given within a couple years of the action worthy of honor (something that occasionally turns sour for the committee, as when a celebrated peace accord crumbles a few years later), but the peace prize has often also been given to the founders of various philanthropic and peace-promoting agencies, whose benefit to the world may only become apparent after years or decades of service.

The parent is absolutely correct in that the work leading to a Nobel is not always representative of a laureate's entire career- an extreme example of this is the share of the 1994 Economics Nobel for John Nash, who of course was 1. not a career economist and 2. sidelined by mental illness for several decades. Sometimes a single paper is all it takes to win a Nobel, rather than some comprehensive program of research lasting years.

Fat Science trumps Fat PROPAGANDA!

[nido]

... I was looking for comments to spend my mod points on, but they'll have to wait.

For proper cholesterol, well, stop eating *#$#$#* crap fats. Cholesterol is made by your liver based on the type of fat you eat.

Polyunsaturated fat - lowers total cholesterol levels
Unsaturated fat - increases good cholesterol
Saturated fat - increases bad cholesteros
Transfat - liquid plastic that'll make sure you get a quad bypass.

Much more important is to stop eating ALL polyunsaturated oils (hydrogenated oils/transfats are usually made from polyunsaturated oils), and replace them with saturated oils.

Fats that are less-than-fully-saturated quickly go rancid when exposed to oxygen.

The saturated fat in beef has been slandered in recent years as being unhealthy. It's not that the beef itself is unhealthy, but that most beef cattle are raised with an unatural diet that includes a great deal of polyunsaturated fats, in the form of grains/soybeans in feedlot animal feed.

Coconut Oil and its Virtues [naturodoc.com]
The Cholesterol Myths [newtrendspublishing.com]: Exposing the Fallacy That Saturated Fat and Cholesterol Cause Heart Disease. (intro chapter in PDF form)
The Tragic Legacy of CSPI [westonaprice.org] (Center for Science in the Public Interest - instigated the anti-saturated fat campaign of the 1980's)
Also see the rest of the articles on fat [westonaprice.org] at the Weston A. Price foundation site.

One reason the polyunsaturates cause so many health problems is that they tend to become oxidized or rancid when subjected to heat, oxygen and moisture as in cooking and processing. Rancid oils are characterized by free radicals--that is, single atoms or clusters with an unpaired electron in an outer orbit. These compounds are extremely reactive chemically. They have been characterized as "marauders" in the body for they attack cell membranes and red blood cells and cause damage in DNA/RNA strands, thus triggering mutations in tissue, blood vessels and skin. Free radical damage to the skin causes wrinkles and premature aging; free radical damage to the tissues and organs sets the stage for tumors; free radical damage in the blood vessels initiates the buildup of plaque. Is it any wonder that tests and studies have repeatedly shown a high correlation between cancer and heart disease with the consumption of polyunsaturates New evidence links exposure to free radicals with premature aging, with autoimmune diseases such as arthritis and with Parkinson's disease, Lou Gehrig's disease, Alzheimer's and cataracts.
-The Skinny on Fats [westonaprice.org]

Doctors don't profit from drugs

[Anonymous Coward]

Perhaps another reason for delay in acceptance of these findings, was that up until the early 90's the * worlds biggest selling drug * was one that inhibits stomach acid production and under patent - unlike cheap as beans & generic broad spectrum antibiotics.

I don't see why this is relevant. Doctors who prescribe medications see not a penny of profit from their sale.

I am a physician, and I have received the occasional pen, note pad, or (once in a long while) a meal from drug reps. Put together, the value of all the freebies I have received from drug companies in my entire career is certainly less than I make from my practice in a week. I have not asked for lavish junkets or cash payments, nor have I ever been offered them.

I prescribe what will work best for my patients, without regard for who profits. Not only do I not take orders from the drug companies, but much of the time (to the drug reps' immense frustration) I can't even remember which company makes which drug. Nor do I care.

The same goes for the AMA, which the conspiracy mongers seem to think controls the brain waves of every doctor in the country. I'm not a member of the AMA, and if someone turned up in my office saying he was from the AMA and intended to tell me how to practice, I'd call the sheriff to throw him out.

Barry Marshall has the respect of every physician, and deserves it. To say that his ideas were intentionally suppressed to protect drug company profits is beyond ludicrous.

The whole affair is just a manifestation of Occam's Razor: extraordinary claims (which his indeed were at the time) require extraordinary proof.

Re:1982!

[Anonymous Coward]

And you demonstrate your ignorance in not understanding that it is precisely the excessive acidic response that H.Pylori stimulates that is responsible for gastritis/ulceration. IT elaborates an enzyme which creates a locally alkaline environment such that the stomach lining over-secretes HCl.