The second day of the recent Pri-Med Southwest Conference & Expo in primary care opened with an expansive keynote address titled “Advances in Medicine in the Last Quarter Century and Predictions About the Future.” Dr. Sanjiv Chopra, Professor of Medicine at Harvard Medical School, and Senior Consultant in Hepatology at the Beth Israel Deaconess Medical Center, Boston, Massachusetts, initiated the session with an address on the topic of Helicobacter pylori (h. pylori).
“What is the most common chronic infection in man?” Dr. Chopra asked at the outset of his presentation. Stating that it is h. pylori, he noted that more than half the world’s population is infected with the bacterium. In other words, more than 3.5 billion people. The infection is most common in developing countries.
Barry Marshall and Dr. Robin Warren earned the Nobel Prize in 1982 for their discovery of h. pylori, Dr. Chopra noted. Their subsequent paper, titled “Unidentified Curved Bacilli in Stomach of Patients with Gastritis and Peptic Ulceration,” appeared in The Lancet in 1984.
Marshall and Warren found the evidence they needed when they unintentionally left petri dishes incubating over a five-day Easter holiday, Chopra said. The historic misstep shed critical light on what Dr. Chopra referred to as “the only ‘itis’ in the body that does not hurt.” From that point on, healthcare providers learned to stop telling their patients that their ulcers were caused by stress or spicy foods.
“We don’t see half the world’s population walking around clutching their abdomens or asking for relief,” Dr. Chopra said.
Yet, the impact of h. pylori infection is significant. For example, “100% of patients with h.pylori disease infection have gastritis,” Dr. Chopra said. The bacterium is also one of just three causes of duodenal ulcers, Dr. Chopra said.
“It’s acid hypersecretion, h. pylori, or use of NSAIDs,” Dr. Chopra said. “If these aren’t present, it’s not a peptic ulcer.”
Dr. Chopra noted that h. pylori can have serious implications in a small subset of patients: Less than 10 percent develop peptic ulcer disease while one or two percent develop gastric cancer.
Yet, resolution can be readily achieved:
“If you have a gastric mortoma and eradicate h. pylori,” Dr. Chopra said, “there can be complete regression of this tumor.”
Dr. Chopra concluded his presentation with these comments:
“In 1910, Carl Schwartz, a physiologist, said, we need a certain amount of acid to have peptic ulcer disease. A dictum we learned in medical school: no acid, no ulcer. We could say in 2021 or 2022, no h.pylori, no ulcer.”