Knight Ridder Newspapers

You gotta love a scientist who drinks a beaker of bacteria just to prove a point. Maybe he slammed down the cup and said, “Hey, you’re givin’ me an ulcer over here.”

Which is just what he was hoping for.

One of the recently named Nobel Prize winners, Barry J. Marshall, felt the need for such a bold gesture. He was trying to upend nearly 100 years of conventional medical wisdom and cultural lore about how people get peptic ulcers. He made himself sick and then used antibiotics.

That was two decades ago, and the word is still getting out: People and pressure don’t give you ulcers, germs do.

Specifically, it’s a bacterium called Helicobacter pylori, a little guy that happens to be a great swimmer and somehow survives the stomach’s acidic stew.

“So it’s not the stock exchange or your Type-A personality,” said Richard McCallum, professor of medicine at the University of Kansas. “The public may not have gotten the full message.”
Nor are ulcers caused by your controlling spouse or rebellious teenager. And it’s not the spicy food you love.

“I have a lot of patients who say, ‘What should I eat? What shouldn’t I eat?’ ” said Richard S. Hart, gastroenterologist at St. Luke’s Hospital in Kansas City, Mo. “Food rarely if ever has any connection to ulcer disease.”

Hart said the original research by Marshall and fellow Australian J. Robin Warren, who share the 2005 Nobel Prize in physiology or medicine for their discovery, was pretty much ignored for a time, including during Hart’s medical training in the 1980s. Through the mid-1990s, in fact, some doctors prescribed acid-blockers for ulcers but not antibiotics.

In the eyes of the public and the medical community, peptic ulcers and stomach problems have long been about so much more than physical ailment. They were emblems of business pressures and sales quotas, long commutes and short deadlines and the complications of modern relationships. With all of that, of course the stomach would bubble up and turn on itself.

For doctors, the mantra was, “No acid, no ulcer.” Stress and other factors created excess acid in the stomach. They prescribed acid blockers, which worked, at least temporarily.

“You can suppress the burning and the pain and even kill the ulcer,” McCallum said. “But after a few months, the tissue breaks down and you form another ulcer.”

Your immune system tries to eliminate H. pylori, but the germ is too sneaky. Killing it requires antibiotics, which works about 85 percent of the time.

But while plenty of Americans harbor the bacteria, not everyone gets an ulcer. Indeed, said McCallum, some have only indigestion or no symptoms at all. This would seem to be a good thing except that long-simmering H. pylori infection is implicated in gastric cancers later in life, he said.

One reason some infected people form ulcers and others don’t is that certain H. pylori strains are more virulent than others. And people who naturally produce more stomach acid are more likely to have ulcers.

And then there’s … stress?

Two psychiatrists in 2003 studied people with ulcer disease and suggested that chronic anxiety might indeed play a role.

They defined anxiety symptoms to include restlessness, irritability, being tense and having trouble concentrating. Those with anxiety symptoms had an increased chance of having a peptic ulcer. With each symptom reported, patients had a 20 percent greater chance of having ulcer disease.

Full circle? No, because even if the psychiatrists are right, worrying alone can’t create an ulcer. But H. pylori points to an interesting time in medicine: While bacteria and viruses are increasingly identified as the root of illnesses, other studies advance the notion that a happy mind is linked to a healthy body, that modern stress makes us sick.

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