Nobel prize is awarded to doctors who discovered H pylori
(Published 06 October 2005)
Cite this as: BMJ 2005;331:795
In choosing Barry Marshall and Robin Warren as winners of the 2005 prize in physiology or medicine, the Nobel awards committee has turned away from basic research this year and plumped instead for old fashioned medical detective work.
Professor Marshall, 54, and Dr Warren, 68, are cited for their 1982 discovery of “the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease.” What the brevity of that citation conceals is the extent to which their work opened the way to a simple cure for a common problem. It also turned an often performed surgical procedure into a relative rarity and stimulated the search for other microbes that may be the cause of chronic conditions.
The two researchers, both Australian, were by no means the first to consider the possibility of a link between microbes and gastric ulcers. The first observations of characteristically curved bacteria among the cells lining the stomach date back to the late 19th century. But because no one could isolate and grow these organisms, the observations were variously neglected or put down to experimental artefact.
As a clinical pathologist at the Royal Perth Hospital, Dr Warren examined many stomach biopsy specimens. He began to notice a parallel between the severity of the inflammation and the number of bacteria present. Working with Professor Marshall, at that time a trainee doctor in the same hospital, he set out to show a causal connection between the two observations.
The pair's initial attempts at culturing bacteria from stomach biopsies were unfruitful. With echoes of Fleming's work on penicillin, their eventual success seems to have owed as much to luck as to judgment. The period that one set of plates was allowed to incubate was unintentionally tripled, allowing a flourishing growth of the microbe we now know as H pylori.
But did the organism cause the inflammation—or was it the inflammation that allowed H pylori to flourish? This chicken and egg uncertainty was resolved in the time honoured manner: through self experimentation. Marshall swallowed a culture of the bacteria, developed gastritis, and then under-went endoscopy and stomach biopsy. H pylori was present in the tissue samples; the requirements of Koch's third and fourth postulates had been met in triumphant fashion.