History - Helicobacter pylori

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History

See also: Timeline of peptic ulcer disease and Helicobacter pylori

In 1875, German scientists found helical shaped bacteria in the lining of the human stomach. The bacteria could not be grown in culture and the results were eventually forgotten.^[3]

In 1893, the Italian researcher Giulio Bizzozero described helical shaped bacteria living in the acidic environment of the stomach of dogs.^[4]

Professor Walery Jaworski of the Jagiellonian University in Kraków investigated sediments of gastric washings obtained from humans in 1899. Among some rod-like bacteria, he also found bacteria with a characteristic helical shape, which he called Vibrio rugula. He was the first to suggest a possible role of this organism in the pathogeny of gastric diseases. This work was included in the "Handbook of Gastric Diseases" but it did not have much impact as it was written in Polish.^[5]

The bacterium was rediscovered in 1979 by Australian pathologist Robin Warren, who did further research on it with Barry Marshall beginning in 1981; they isolated the organisms from mucosal specimens from human stomachs and were the first to successfully culture them.^[6] In their original paper,^[7] Warren and Marshall contended that most stomach ulcers and gastritis were caused by infection by this bacterium and not by stress or spicy food as had been assumed before.^[8]

The medical community was slow to recognize the role of this bacterium in stomach ulcers and gastritis, believing that no microorganism could survive for long in the acidic environment of the stomach. The community began to come around after further studies were done, including one in which Marshall drank a Petri dish of H. pylori, developed gastritis, and the bacteria were recovered from his stomach lining, thereby satisfying three out of the four of Koch's postulates. The fourth was satisfied after a second endoscopy ten days after inoculation revealed signs of gastritis and the presence of "H. pylori". Marshall was then able to treat himself using a fourteen day dual therapy with bismuth salts and metronidazole. Marshall and Warren went on to show that antibiotics are effective in the treatment of many cases of gastritis. In 1994, the National Institutes of Health (USA) published an opinion stating that most recurrent gastric ulcers were caused by H. pylori, and recommended that antibiotics be included in the treatment regimen.^[9] Evidence has been accumulating to suggest that duodenal ulcers are also associated with H. pylori infection.^[10][11] In 2005, Warren and Marshall were awarded the Nobel Prize in Medicine for their work on H. pylori.^[12]

Before the appreciation of the bacterium's role, stomach ulcers were typically treated with medicines that neutralize gastric acid or decrease its production. While this worked well, the ulcers very often reappeared. A very often used medication against gastritis and peptic ulcers was bismuth subsalicylate. It was often effective, but fell out of use, since its mechanism of action was a mystery. Nowadays it is quite clear that it is due to the bismuth salt acting as an antibiotic. Today, many stomach ulcers are treated with antibiotics effective against H. pylori.

The bacterium was initially named Campylobacter pyloridis, then C. pylori (after a correction to the Latin grammar) and in 1989, after DNA sequencing and other data showed that the bacterium did not belong in the Campylobacter genus, it was placed in its own genus, Helicobacter. The name pylōri means "of the pylorus" or pyloric valve (the circular opening leading from the stomach into the duodenum), from the Greek word πυλωρός, which means gatekeeper.

While H. pylori remains the most medically important bacterial inhabitant of the human stomach, other species of the Helicobacter genus have been identified in other mammals and some birds, and some of these can infect humans.^[13] Helicobacter species have also been found to infect the livers of certain mammals and to cause liver disease.^[14]