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DIGESTIVE DISEASES: SOON WE WON?T HAVE TO WORRY ABOUT ULCERS
Dr. Frank Hamilton heads the ulcer program at the National Institute of Diabetes and Digestive and Kidney Diseases in Bethesda, Maryland. Like other scientists working on ulcers, Dr. Hamilton could not suppress his excitement about the subject: “This is one of the biggest breakthroughs in gastroenterology in the last three decades. For the first time, we can say there is an organism that causes peptic ulcer disease – and we can treat it.”
The leading doctors I interviewed agreed that, from now on, ulcers could become a rare disease, killing far fewer than the estimated 6,000 patients who die in the U.S. annually, according to the National Center on Health Statistics. The doctors also predict that most patients will be cured – and forget they ever had ulcers.
Jay Neitz, 41, teaches neuroscience at the Medical College of Wisconsin in Milwaukee. Since the third grade, he had suffered from peptic ulcers. “They thought it was because of worry,” Mr. Neitz recalls. “I went to psychiatrists. I knew I wasn’t worried. I just had a sore stomach. This went on for 30 years.”
Doctors tried to control his ulcer with a bland diet and pills that neutralize stomach acid. Then, 20 years ago, scientists developed Tagamet, which reduces the production of stomach acid. “That was much better,” Mr. Neitz says, “but I still had terrible symptoms: nausea, stomach cramping, burning. Sometimes, I got down on the floor and curled up in pain.”
Four years ago, Mr. Neitz was treated by Dr. Amnon Sonnenberg, an associate professor of medicine, also at the Medical College of Wisconsin. The news of the antibiotic treatment of ulcers had just begun to spread. Dr. Sonnenberg gave Mr. Neitz the new antibiotic therapy.
“The amazing thing is that not only do I not have an ulcer anymore,” Mr. Neitz says, “but I also don’t have stomach problems – no heartburn, nothing. The pain was gone in 6 weeks. I can now drink coffee and eat spicy foods, which I love. This treatment gave me a new life.”
Dr. Barry Marshall, formerly a clinical associate professor at the University of Virginia in Charlottesville, was one of the discoverers that the bacterium is the cause of ulcers. In 1981, Dr. Marshall was a young internist at the Royal Perth Hospital in Western Australia. He teamed up with Dr. Robin Warren, a pathologist who also was working there.
Both doctors had noticed a bacterial infection in the lining of the stomachs of patients in the hospital and tried to find out more about it with a simple patient questionnaire. “Out of 100 patients with various diseases,” Dr. Marshall says, “65 percent were tested and found to have the infection, and half of these were found to have ulcers. My colleagues were astounded. They had been taught, as I was, that germs could not live in acid.”
In 1986, in a treatment study among patients whose ulcers would not go away, Dr. Marshall gave half of them Tagamet, the acid suppressant; he gave antibiotics to the other half – Flagyl with bismuth. Among the patients treated with Tagamet only, their ulcers returned at the rate of 95 percent. Among those treated with Flagyl and bismuth, ulcers returned in only 20 percent of the cases.
“By the end of 1986,” Dr. Marshall says, “we knew that all these people were better. After a month or two, the patients started eating pepperoni pizza. The patients couldn’t believe it.”
Because some doctors couldn’t believe it either, Dr. Marshall put himself at some risk to prove his hypothesis: he infected himself by swallowing a teaspoonful of culture containing the bacteria. “I came down with gastritis [inflammation of the stomach],” he recalls. As further proof of his theory, he says, antibiotics cured him.
Dr. Marshall adds that not all patients are cured for various reasons, one of which is that sometimes the bacteria develop resistance to the antibiotics.
The new findings even may help prevent stomach cancer. Dr. Martin Blaser, director of the Division of Infectious Diseases at Vanderbilt University School of Medicine in Nashville, asserts, “Stomach cancer is the world’s number two cancer killer. In the United States it ranks ninth among men and eleventh among women. But the risk is higher in blacks than in whites, and higher still in Asian Americans and Native Americans.
“The World Health Organization declared Helicobacter pylori a type 1 carcinogen – the most dangerous type,” says Dr. Blaser. “With it, your risk for stomach cancer goes way up. Preventing infection is a goal, but a vaccine is at least 10 years away.” Meanwhile, the antibiotic therapy of Dr. Marshall and careful hygiene should help control the bacterium and reduce the incidence of stomach cancer.
With antibiotics, the need for ulcer surgery also should be reduced – and so should medical costs.
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Other names: Urso

DIGESTION: SALIVARY GLANDS
The ones which force themselves most on our attention are the salivary glands of the mouth. You know that they are big enough to make a lot of fluid. But all along the canal are innumerable minute ones. Many of these secrete mucus, which lubricates. The others secrete “enzymes.” Enzymes are substances indispensable to the chemical reactions of the body. They would seem to be practically infinite in number and we know of most of them only by the results which they accomplish. They will be discussed later when we come to vitamins and hormones, the three being said to be one family.
Some of these enzymes have been identified and collected and occur in large amounts. The digestive enzymes, of which I have seen eighteen listed, are in this class. A few are well known: ptyalin of the saliva which changes starch to sugar is one. Perhaps the best known is pepsin of the gastric juice which certainly in my younger days everybody knew about. Every family bought it at the drugstore or got it in chewing gum. We were told that it came from the stomachs of hogs and digested protein. All of us medical students knew of the euphonious trio, trypsin, steapsin, and amylopsin, which comes from the pancreas and which transforms proteins, fats, and starches, respectively.
Although there is ptyalin in the saliva and it helps to digest starch, the chief use of the saliva is undoubtedly to soften food and make it easy to swallow. Several pints may be secreted daily. Americans apparently have plenty of saliva – at any rate, they have led the world in spitting, as has been commented on by English travelers. Mrs. Trollope in 1830 was disgusted with this habit; and later Charles Dickens, in his notes on his American tours, complained that Americans spat before him. Nowadays our supremacy in gum chewing, which, of course, keeps saliva flowing, makes several pints seem a reasonable figure.
Saliva is secreted by several sets of glands, the parotids in front of the ears being much the larger. I know not why mumps, or epidemic parotitis, which is so remarkably infectious, has a predilection for these glands. Neither do I know why in adult males the disease so often jumps to the testicles, often causing atrophy here. One of my internist friends told me that in the First World War the sickest patients he saw were those with mumps. For these reasons, I am inclined to think that one might find it the course of wisdom to let one’s children have the mumps, as the disease is mild in youth.
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