Few people know that French icon Napoleon Bonaparte and the great twentieth century Irish novelist James Joys, had one thing in common- they both died of a disease with high acidity in their belly- the acid peptic disease with ulcers in their stomach and upper part of their intestine which ruptured or bled profusely leading to their untimely death.

This civilisation old disease has been for around 57000 years in human beings as calculated by DNA dating technique. Needless to say that it has taken a huge toll for centuries. Even today it is a pandemic disease in entire developing world and also seen amongst marginalised population in rich countries.

In recent times the celebrated Croatian physician’ Karl Schwartz ‘ in 1910 , gave a detailed account of this disease and demonstrated the presence of ulcers in  stomach amongst dead .He famously said ‘ No Acid No Ulcer’  and made it known as ‘peptic ulcer disease’  which thrives on account of high acidity.

This Acid Peptic disease or peptic ulcer disease clinically manifests  as feeling of burning sensation and pain behind the lower part of sternum or beneath upper abdomen , generally early in the morning in fasting state with occasional water brash or heart burn which gets relieved with some food such as milk or alkali such as Calcium carbonate, milk of magnesia and by Bismuth salts , only to reappear again and again through  the days and months till it bursts or lead to bleeding and death.

Dr James Black, a Scottish pharmacologist working with Smith, Kline’s British laboratory identified the specific histamine hormone subtype H2 receptor blocker, which chokes the acid secretion from the stomach’s acid secreting oxyntic cells and allows prolonged relief from pain and even healing occasionally. Such was the demand for this H2 blocker molecule, which generally very obtrusive American drug regulators - The FDA, took only a few hours to approve H2 blockers and tablet TAGAMET of Smith Kline remained the bestselling drug for decades. Appropriately Dr James Black received the coveted Nobel prize in 1988 for his seminal research on H2 blocker.

However, the LASTING CURE was still elusive as cause of high acidity and disease vulnerability in such vast population was yet to be arrived at.

HYPER ACIDITY IS DUE TO TINY BACTERIA!

As mentioned above, the concept for a very long time was that, it is bad food and mental stress which causes this disease. Attention remained centered around controlling anxiety - stress and neutralising the acidity.

The much needed breakthrough came in 1979 from Doctors working in a rather unsophisticated set up ( by American standards ) The Royal Perth Hospital , Australia , which had taken lead in using fibre optic endoscopes for directly visualising internal surfaces of stomach and extracting tissues of interest since 1970 . Here, Dr Robin Warren, a noted pathologist famous for his research interests in gastroenterology, noticed the presence of very tiny microscopic curved bacteria, Helicobacter pylori (Helico meaning curved) present consistently in samples collected from patients with stomach ulcers. In order to extend his interest in this curved microscopic creature, he recruited a bright young doctor named Dr Barry Marshal. Both of them jointly created a series of such patient’s gastric juice analysis and found that such bacteria were present in more than four fifths of the ulcer samples. However, they were seen also in those without ulcers but in much smaller numbers creating some confusion! Prestigious journal ‘Lancet ‘published their account reluctantly after a long debate in the year 1984.

In order to prove that this bacteria is the cause of the disease, Dr Marshal went a step further and infected himself by swallowing bacteria containing broth and seeding these bacteria in his stomach leading to ulcer formation which developed within a few weeks of ingestion . This confirmed the cause - effect relationship and established the bacteria as the definitive cause. It was huge news everywhere ! However , this time they sent their research findings to ‘Australian journal of gastroenterology ‘ instead of journal ‘ Lancet ‘and it got huge reception from the entire scientific community . This discovery led to coveted Nobel prize in the year 2005 for physiology or medicine for this brilliant Australian duo .

In the absence of easy diagnostic tools and established treatment protocols it took several years before it could be received enthusiastically by the treating physicians specially due to lack of endoscopy facilities in many resource poor countries .

In 1984 Microbiologists from Amsterdam reported the presence of a large amount of ‘ urease ‘in stomach ulcer samples . Dr Marshal developed a test kit which could easily diagnose the presence of H. pylori indirectly by finding out ‘urease ‘ in the sample of gastric juice. Later on ‘urea breath test ‘was developed on similar principle.  Yet another diagnostic tool to identify the bacteria by testing small amount of blood containing antibodies specific to the H pylori , made the diagnosis even easier and definitive.

THIS IS AN  INFECTIVE DISEASE WHICH SPREADS THROUGH CONTAMINATED FOOD AND WATER  !!

With better understanding and   by adopting appropriate hygiene such as hand washing before food and by avoiding community eating   in one utensil , this disease is coming under control in rich countries but continues even today in very large population of third world countries where socioeconomic conditions delay adopting such appropriate behaviour.

THE MUCH NEEDED TREATMENT !

Dr Marshal continued his efforts and found out that multiple antibiotics in the company of better anti acid molecules eliminated these H . pylori bacteria more effectively.

In the meantime Astra , a Swedish Pharmaceutical heavyweight discovered the proton pump inhibitors ( PPI) which was considered even more effective than H2 blockers in reducing the acidity of the stomach . Now a combination of three or more oral antibiotics in company of PPI offered a much comprehensive treatment to control and eradicate this bacteria induced acid peptic disease and it’s complications such as cancer of the stomach prevalent in many parts of the world such as Japan .

It is not a surprise that now scientists have started looking into many ulcerative and inflammatory diseases of abdomen from microscopic angle and trying to find some microorganisms as the cause of many difficult to treat diseases!

The author is former Professor and Head of Medicine, RIMS, Ranchi.