WEBVTT - Ep 28 H. pylori: Don't try this at home 0:00:00.800 --> 0:00:02.679 I decided that I was going to have to drink 0:00:02.680 --> 0:00:05.440 the bacteria myself. I thought I would just be having 0:00:05.440 --> 0:00:08.160 no symptoms for a few years, after which I would 0:00:08.160 --> 0:00:12.160 have an ulcer and then hallelujah, it'd be proven. Actually 0:00:12.240 --> 0:00:15.320 I was very shy about this experiment. I didn't tell anyone, 0:00:15.320 --> 0:00:18.919 not even my wife or Robin until afterwards. I asked 0:00:18.920 --> 0:00:22.480 my boss in gasterentrology, Ian Hyslop, to do an endoscopy 0:00:22.520 --> 0:00:24.919 for me one day. As he put the scope down me, 0:00:25.000 --> 0:00:27.120 he was saying, Berry, I'm not going to ask why 0:00:27.160 --> 0:00:30.040 I'm doing this, and from around the tubing, I gritted out, 0:00:30.320 --> 0:00:33.839 just take the biopsy. So he took some biopsies from 0:00:33.880 --> 0:00:37.400 me and they were all clear, no bacteria. Then I 0:00:37.440 --> 0:00:40.720 infected myself with bacteria that i'd cultured from a patient 0:00:40.960 --> 0:00:44.560 who did not actually have ulcers, just indigestion and gastritis. 0:00:45.040 --> 0:00:48.160 I was able to eradicate his infection with some antibiotics, 0:00:48.360 --> 0:00:51.559 so already I knew that I could, if necessary, take 0:00:51.560 --> 0:00:54.440 a treatment which worked on this bug. I had some 0:00:54.480 --> 0:00:57.760 safety features built in. I thought I drank the bacteria, 0:00:57.840 --> 0:00:59.840 and at first I was okay. 0:00:59.720 --> 0:01:00.440 But instead of. 0:01:00.440 --> 0:01:03.840 Being perfectly well and having a silent infection. After about 0:01:03.880 --> 0:01:08.240 five days, I started having vomiting attacks. Typically at dawn. 0:01:08.280 --> 0:01:10.759 I would wake up, run to the toilet, and vomit. 0:01:11.319 --> 0:01:13.360 And it was a clear liquid, as if you had 0:01:13.400 --> 0:01:16.199 drunk a pint of water and regurgitated it straight back. 0:01:16.760 --> 0:01:19.160 Not only that there was no acid in it. I 0:01:19.200 --> 0:01:21.840 remembered from my medical student days that if you have 0:01:21.880 --> 0:01:24.039 a meal where you drink so much beer that it's 0:01:24.080 --> 0:01:26.600 coming back up straight away, it doesn't have any acid 0:01:26.640 --> 0:01:29.840 in it. I knew there was something unusual about vomiting 0:01:30.040 --> 0:01:33.760 and not having acid, and this is just one experiment 0:01:33.800 --> 0:01:37.399 on yourself, and you say, am I imagining this? Until 0:01:37.400 --> 0:01:39.760 I had another biopsy, I couldn't know for certain that 0:01:39.840 --> 0:01:43.679 I had the bacteria. Finally, after ten days, I had 0:01:43.720 --> 0:01:48.240 the biopsy, had another endoscopy, and the bacteria were everywhere 0:01:48.960 --> 0:01:52.040 in the lining of my stomach. There were absolute millions 0:01:52.160 --> 0:01:55.120 of the white cells that we call pus cells polymorphs. 0:01:55.560 --> 0:01:58.440 There was no acid being produced by my stomach. I 0:01:58.560 --> 0:02:02.080 was very uncomfortable with that endoscopy, gagging and throwing up. 0:02:02.440 --> 0:02:05.720 But I'd proven that the bacteria could infect a healthy 0:02:05.760 --> 0:02:52.760 person and cause gastritis. I'd proven Robin's disease. That's a 0:02:52.800 --> 0:02:53.399 really good one. 0:02:53.800 --> 0:02:57.480 I love that one. The words from the man himself, 0:02:57.800 --> 0:03:02.200 very Marshall. So that was from an interview conducted by 0:03:02.280 --> 0:03:04.880 doctor Norman Swan in two thousand and eight for the 0:03:04.919 --> 0:03:06.520 Australian Academy of Science. 0:03:07.160 --> 0:03:09.480 Sorry I didn't read it in an Australian accent. 0:03:11.880 --> 0:03:13.640 I'm not think that everyone will forgive you. 0:03:15.440 --> 0:03:17.400 I think they'll be thankful for. 0:03:20.040 --> 0:03:20.239 Hi. 0:03:20.720 --> 0:03:21.960 I'm erin Welsh and. 0:03:21.880 --> 0:03:23.480 I'm erin Allman Updyke. 0:03:23.440 --> 0:03:25.440 And this is this podcast will kill you. 0:03:25.880 --> 0:03:30.080 And today we're talking about Helicobacter pylorie. 0:03:30.840 --> 0:03:37.040 Wonderful little bacteria, just such a gem. Okay, So before 0:03:37.080 --> 0:03:40.720 we get into all of the nitty gritty of the 0:03:41.080 --> 0:03:44.360 horrible things that it can do to you, let's get 0:03:44.400 --> 0:03:46.440 into the nitty gritty of what we're drinking. What is 0:03:46.480 --> 0:03:47.520 our quarantine ee? 0:03:47.800 --> 0:03:49.960 Well, of course it's Barry's beaker. 0:03:52.160 --> 0:03:55.880 Barry because Barry Marshall, one of the co discoverers of 0:03:55.920 --> 0:04:00.280 this link between H. Pylori and ulcers and gastritis. 0:04:00.280 --> 0:04:02.480 Et cetera, who we just heard from in our first 0:04:02.520 --> 0:04:03.120 hand account. 0:04:03.320 --> 0:04:07.000 Yeah, and so imagine as you're sipping this quarantini that 0:04:07.120 --> 0:04:11.800 you are Barry Marshall taking that sip of the inoculate 0:04:12.640 --> 0:04:16.800 of hpylory to give yourself gastritis. 0:04:16.839 --> 0:04:20.159 So yum, in the name of science, in the name 0:04:20.200 --> 0:04:21.359 all in the name of science. 0:04:21.520 --> 0:04:22.800 That's what we cheers to today. 0:04:23.240 --> 0:04:26.239 Yes, so what are we cheersing with? What's in this drink? 0:04:26.480 --> 0:04:26.600 Oh? 0:04:26.640 --> 0:04:30.960 Yeah, okay, So it has got coffee because coffee definitely 0:04:31.120 --> 0:04:37.040 exacerbates ulcers. Ulcers. It's got well alcohol in the form 0:04:37.080 --> 0:04:38.840 of rye whiskey mm hm. 0:04:39.680 --> 0:04:46.320 It's got chocolate liqueur and hazelnut syrup. Yes, yum, soups dillish. 0:04:46.360 --> 0:04:49.000 And so we'll post the recipe for that quarantini and 0:04:49.080 --> 0:04:51.440 for our non alcoholic placey Berita on all of our 0:04:51.440 --> 0:04:53.080 social media pages. 0:04:53.200 --> 0:04:56.920 TPWKY on Twitter, and this podcast will Kill You on 0:04:56.960 --> 0:05:00.560 Facebook and Instagram, and we'll also post it on our website, 0:05:00.720 --> 0:05:03.919 This Podcast will Kill You dot Com, where if you 0:05:03.960 --> 0:05:05.720 haven't already you can also find. 0:05:05.480 --> 0:05:07.599 Our merch yep. 0:05:08.160 --> 0:05:11.760 All right, so should we just jump right into the 0:05:11.839 --> 0:05:12.680 podcast today? 0:05:13.080 --> 0:05:15.520 Yeah, I'm really excited about this one. We too. 0:05:15.720 --> 0:05:19.240 We're always excited though, like I know, it's it's good 0:05:20.720 --> 0:05:21.400 after this. 0:05:21.360 --> 0:05:57.520 Quick break, all right, h Pylori The bacterium. 0:05:58.839 --> 0:05:59.679 Dump dump dorm. 0:06:00.120 --> 0:06:00.600 There we go. 0:06:01.680 --> 0:06:07.479 Helicobacter pylori is a gram negative bacterium, and the truth 0:06:07.600 --> 0:06:11.280 is that over eighty percent of people who are infected 0:06:11.760 --> 0:06:13.479 are asymptomatic. 0:06:13.760 --> 0:06:15.760 So that's probably at least one of us. 0:06:16.520 --> 0:06:21.320 Yeah, statistically speaking, it's highly likely. So that's interesting. I 0:06:21.360 --> 0:06:22.640 never thought about getting tested. 0:06:23.000 --> 0:06:26.320 Have you ever had any ulcer symptoms or gastritis? 0:06:26.760 --> 0:06:30.760 No, well, I having some right now, but that's unrelated. 0:06:32.480 --> 0:06:33.920 Another burto for breakfast. 0:06:34.560 --> 0:06:39.760 Well you know, okay, So H. Pylori is shaped a 0:06:39.800 --> 0:06:41.880 little bit like a helix, which is where it gets 0:06:41.920 --> 0:06:45.760 the name helicobacter from. But it's not a spiral keet 0:06:45.800 --> 0:06:48.880 like a spiraled bacteria. It's actually just a curved rod. 0:06:49.800 --> 0:06:54.880 And importantly, it has flagella on it, which it uses 0:06:54.920 --> 0:06:58.400 to move, and it's a very highly motile bacteria. And 0:06:58.440 --> 0:07:01.919 that'll become even more important we talk about the pathophysiology 0:07:01.960 --> 0:07:08.159 of this disease, so the transmission is actually not entirely clear, 0:07:08.560 --> 0:07:10.080 which I think is so interesting. 0:07:10.640 --> 0:07:12.720 Yeah, that is really interesting. 0:07:13.000 --> 0:07:15.920 Yeah, we don't really know how people get infected. The 0:07:15.960 --> 0:07:20.080 thing is, it's estimated that up to fifty percent of 0:07:20.120 --> 0:07:22.280 the world's population is infected with H. 0:07:22.320 --> 0:07:22.760 Pylori. 0:07:23.440 --> 0:07:26.920 Is it vertically transmitted then, like mother to offspring. 0:07:26.840 --> 0:07:27.560 Great question. 0:07:29.040 --> 0:07:32.080 I haven't seen any data that suggests that it's directly 0:07:32.160 --> 0:07:35.520 vertically transmitted. Most of the data that I've seen suggests 0:07:35.520 --> 0:07:39.120 that it's either fecal oral or just through saliva. Okay, 0:07:39.160 --> 0:07:40.960 So it could be that mothers pass it to their 0:07:41.000 --> 0:07:44.760 offspring indirectly, but not directly through what we would normally 0:07:44.840 --> 0:07:46.280 consider vertical transmission. 0:07:46.520 --> 0:07:49.080 Okay, okay, interesting, But yeah, it's. 0:07:49.040 --> 0:07:54.160 Very interesting that it's unclear how this bacteria that is 0:07:54.200 --> 0:07:57.000 so widespread is actually transmitted. 0:07:57.000 --> 0:07:59.680 And so it's is it because it could be transmitted 0:07:59.720 --> 0:08:03.360 in an many different ways, it's likely not just one, 0:08:04.160 --> 0:08:05.040 I mean potentially. 0:08:05.160 --> 0:08:07.000 Yeah, I really don't know. 0:08:09.480 --> 0:08:10.760 That's not what I was expecting. 0:08:11.120 --> 0:08:12.880 I know, it's not what I was expecting either. 0:08:13.960 --> 0:08:16.240 Cool, it's yeah, there's not a lot of evidence that 0:08:16.280 --> 0:08:19.360 it necessarily persists in the environment, but the fact that 0:08:19.400 --> 0:08:22.560 it's so widespread suggests that maybe it actually does somehow. 0:08:23.800 --> 0:08:26.160 And the other thing is that it's really easy to 0:08:26.320 --> 0:08:29.880 infect children, but the people who tend to be most 0:08:30.040 --> 0:08:33.000 infected are actually adults and not necessarily children. 0:08:33.320 --> 0:08:34.680 So that's pretty weird too. 0:08:35.200 --> 0:08:37.800 So children clear the infection. 0:08:38.040 --> 0:08:40.960 Maybe, but then do they get reinfected or is it 0:08:41.000 --> 0:08:44.400 just that they actually don't get infected as children, Like, 0:08:44.440 --> 0:08:46.440 if you screen a bunch of children, most of them 0:08:46.440 --> 0:08:48.599 are not going to be infected. If you screen a 0:08:48.600 --> 0:08:50.920 bunch of adults, a lot of them will be infected. 0:08:51.720 --> 0:08:56.280 But children are just as susceptible as adults. And usually 0:08:56.320 --> 0:08:59.079 if you have something that's transmitted fecal oral, you might 0:08:59.080 --> 0:09:02.040 think that children would get it more frequently than adults 0:09:02.080 --> 0:09:04.680 because they're more likely to put poop in their mouths 0:09:04.679 --> 0:09:10.920 and things. Yeah, anyways, we don't know exactly how it's transmitted, 0:09:11.760 --> 0:09:14.559 but we do know the kinds of symptoms that it causes. 0:09:15.160 --> 0:09:19.480 So acutely an acute infection, shortly after you're infected, you 0:09:19.520 --> 0:09:23.120 can get symptoms of acute gastritis, which basically is just 0:09:23.200 --> 0:09:27.000 inflammation and irritation of the gastrointestinal tract. So maybe some 0:09:27.080 --> 0:09:31.160 abdominal pain, maybe some nausea like good old Berry. 0:09:31.360 --> 0:09:32.760 Tended to experience. 0:09:32.960 --> 0:09:36.359 That's like, But often you don't get any of these symptoms. 0:09:36.400 --> 0:09:40.920 What usually happens is that the helicobacter develops into a 0:09:41.040 --> 0:09:45.680 chronic infection. It basically just lives makes a home in 0:09:45.720 --> 0:09:51.319 your stomach mucosa. And this is impressive because your stomach 0:09:51.480 --> 0:09:57.040 is a pretty inhospitable environment. Right, The pH is like two, 0:09:57.080 --> 0:09:59.720 it's between one point five and three point five, which 0:09:59.760 --> 0:10:03.680 is really really acidic. And on top of that, it's 0:10:03.760 --> 0:10:06.960 constantly moving. Your stomach fills up with food and then 0:10:07.000 --> 0:10:10.040 it has to empty out and to keep all of 0:10:10.080 --> 0:10:12.600 the stuff that you eat from going back up and 0:10:12.640 --> 0:10:16.160 out eu esophagus, it's always undergoing peristalsis, which are these 0:10:16.280 --> 0:10:19.360 rhythmic contractions that it does in order to push the 0:10:19.400 --> 0:10:22.720 food out into your duodenum, which is the first part 0:10:22.800 --> 0:10:27.320 of your small intestine. So it's not a static environment. 0:10:27.400 --> 0:10:31.880 It's a super dynamic environment. So how can this measly 0:10:31.920 --> 0:10:36.239 little bacterium survive in such difficult conditions? 0:10:37.320 --> 0:10:37.920 Do you want to know? 0:10:38.160 --> 0:10:40.320 I do want to know why I'm here. 0:10:41.000 --> 0:10:44.840 It has two main mechanisms by which it's able to survive. 0:10:45.559 --> 0:10:49.240 First of all, it has those flagella. So flagella are 0:10:49.280 --> 0:10:53.160 basically protein structures coming off of bacteria that they can 0:10:53.320 --> 0:10:58.360 use to swim. So once the Helicobacter pylori makes it 0:10:58.400 --> 0:11:01.160 into your stomach, it can resist being flushed out of 0:11:01.160 --> 0:11:03.600 your stomach with the rest of your food, because it 0:11:03.600 --> 0:11:05.040 can swim against the current. 0:11:05.760 --> 0:11:10.400 That's a very powerful little flagella, I know, flagellum. 0:11:10.720 --> 0:11:11.680 Yeahagellum. 0:11:11.920 --> 0:11:13.960 They have like four, so you could say flagella. 0:11:14.120 --> 0:11:16.360 Okay, those are some powerful flagella. 0:11:16.559 --> 0:11:18.000 Yeah, they're really powerful. 0:11:18.040 --> 0:11:19.760 And then they can use them not just to swim 0:11:19.800 --> 0:11:22.960 against the current of peristalsis, but to swim down into 0:11:23.000 --> 0:11:27.440 the mucus that lines your stomach. So for a little 0:11:27.480 --> 0:11:32.720 bit of basic stomach anadome. Because your stomach is such 0:11:32.720 --> 0:11:36.079 a harsh acidic environment, your stomach cells produce a ton 0:11:36.160 --> 0:11:39.600 of mucus, and that mucus lines your stomach cells in 0:11:39.679 --> 0:11:43.680 order to protect your own cells from getting eaten roy 0:11:43.880 --> 0:11:48.040 and eroded by that acid. So the mucus forms this 0:11:48.160 --> 0:11:51.600 like protective lining. The helicobacter can use those flagellas to 0:11:51.679 --> 0:11:56.760 kind of burrow their way into that mucus layer. Oh yeah, 0:11:56.880 --> 0:12:01.280 it's pretty cool, and a lot of times they actually 0:12:01.360 --> 0:12:04.640 live in that mucus layer, but if they wanted to, 0:12:05.120 --> 0:12:07.920 they could swim down through that mucus layer and actually 0:12:07.960 --> 0:12:11.959 attach directly to the epithelial cells. They have these special 0:12:11.960 --> 0:12:19.320 proteins called adhesons that adhere to the epithelial cells, and 0:12:19.360 --> 0:12:21.760 that way, it's another mechanism by which they can make 0:12:21.760 --> 0:12:25.600 sure they don't get flushed out. Okay, So they're very 0:12:25.640 --> 0:12:29.600 good at a swimming against the current down into your 0:12:29.720 --> 0:12:34.240 mucus and potentially attaching to your epithelial cells. So that's 0:12:34.280 --> 0:12:37.600 the first way that they're able to survive. The second 0:12:37.600 --> 0:12:44.319 way is that they actually can neutralize their own micro environment. 0:12:45.160 --> 0:12:48.079 Oh cool, right, sort of like their own little pod 0:12:48.840 --> 0:12:52.800 of bubble, like a little the bacteria bubb right exactly. 0:12:53.240 --> 0:12:57.360 So if the pH directly surrounding the bacteria is too 0:12:57.440 --> 0:13:01.240 low or too acidic, they produce urine, which is an 0:13:01.360 --> 0:13:04.920 enzyme that breaks down urea, which is a normal waste 0:13:04.920 --> 0:13:08.720 product that's found throughout your body that when it's broken down, 0:13:08.960 --> 0:13:13.280 breaks down into carbon dioxide and ammonia, and ammonia is 0:13:13.320 --> 0:13:19.360 a base. This base neutralizes the acid immediately surrounding Helicobacter 0:13:19.640 --> 0:13:23.320 bacteria so that they can live happily ever after in 0:13:23.360 --> 0:13:25.600 a slightly less acidic environment. 0:13:26.080 --> 0:13:27.840 Hmmmm, isn't that cool? 0:13:28.160 --> 0:13:29.160 That's really cool. 0:13:29.640 --> 0:13:32.400 So they're good swimmers, they can stick to your cells, 0:13:32.520 --> 0:13:35.680 and they they change their own micro environment to be 0:13:35.840 --> 0:13:38.880 more hospitable for their growth and survival. 0:13:39.360 --> 0:13:40.240 Huh. 0:13:40.320 --> 0:13:44.080 Okay, So the thing about H. Pylori infection is that 0:13:44.120 --> 0:13:49.679 there are two different interrelated long term issues associated with 0:13:49.920 --> 0:13:53.480 chronic H. Pylori infection, because again, this is a bacteria 0:13:53.640 --> 0:13:57.319 that essentially makes its home in your stomach and lives 0:13:57.360 --> 0:14:01.880 there for a very very long time. All Right, these 0:14:01.960 --> 0:14:06.880 two different issues. They're related, but they're also kind of opposite, 0:14:06.920 --> 0:14:09.600 which I think is really interesting and it seems like 0:14:09.679 --> 0:14:14.640 it's not entirely understood yet. But the issue that you 0:14:14.840 --> 0:14:18.160 end up with depends on where in your stomach these 0:14:18.200 --> 0:14:19.720 bacteria colonize. 0:14:19.880 --> 0:14:22.800 Okay, Okay, So if H. 0:14:22.880 --> 0:14:26.360 Pylori colonizes in what's called the antrum of your stomach, 0:14:26.480 --> 0:14:29.600 which is closer to the output end of your stomach, 0:14:30.920 --> 0:14:34.640 then what it tends to do by mechanisms we don't 0:14:34.640 --> 0:14:40.440 fully understand, is it causes hyper secretion of acid, so 0:14:40.480 --> 0:14:45.400 it actually increases your acid output, and if your stomach 0:14:45.600 --> 0:14:49.240 is making too much acid, that acid overflows out of 0:14:49.240 --> 0:14:54.160 your stomach and into your duodenum. This causes chronic irritation 0:14:54.440 --> 0:14:59.920 of your duodenum that leads to what we call gastric metaplasia. 0:15:00.440 --> 0:15:05.040 Means your stomach and metaplasia means your cells are changing 0:15:05.760 --> 0:15:10.440 in shape and type. So it means that your intestinal 0:15:10.480 --> 0:15:14.240 cells start to look more like your stomach cells. 0:15:14.520 --> 0:15:16.040 Ooh, that's really weird. 0:15:16.320 --> 0:15:19.640 It's really weird, and it's not good. This leads to 0:15:19.880 --> 0:15:25.400 duodenal ulcers. Okay, Okay, So you've got acids spilling out 0:15:25.400 --> 0:15:29.440 of your stomach into your duodenum, causing irritation and cell 0:15:29.560 --> 0:15:33.880 changes that lead to ulceration, which are basically holes that 0:15:34.000 --> 0:15:36.800 form in the layers of your small intestine. 0:15:37.360 --> 0:15:39.960 Okay, So I have a question. So you said that 0:15:40.320 --> 0:15:44.280 if the bacteria are in the output end of your stomach, 0:15:44.840 --> 0:15:48.440 then stomach acid production increases, but doesn't make Doesn't that 0:15:48.480 --> 0:15:51.480 make the environment more inhospitable? So is it? Is it 0:15:51.520 --> 0:15:55.880 your body's reaction. It's not the bacteria that are producing 0:15:55.960 --> 0:15:59.040 the acid, it's your body being like, wait, there's your 0:15:59.120 --> 0:16:00.000 neutralizing too much. 0:16:01.160 --> 0:16:04.040 That's a really great question. It's not entirely clear. It 0:16:04.160 --> 0:16:08.720 suggested that maybe they damage certain cells that would decrease 0:16:08.840 --> 0:16:13.160 acid production, so then they end up overproducing acid because 0:16:13.200 --> 0:16:17.160 those like inhibitory cells are damaged. It's totally unclear, and 0:16:17.200 --> 0:16:19.280 it's about to get even weirder because that's not the 0:16:19.280 --> 0:16:23.200 weird good great, yeah, okay, so that's how you end 0:16:23.280 --> 0:16:24.880 up getting duadenal ulcers. 0:16:24.960 --> 0:16:25.720 If you have an H. 0:16:25.760 --> 0:16:28.680 Pylori infection, that's not the only thing you can end 0:16:28.760 --> 0:16:29.080 up with. 0:16:29.840 --> 0:16:30.280 If H. 0:16:30.360 --> 0:16:34.480 Pylori colonizes higher up in what's called the body of 0:16:34.520 --> 0:16:37.840 your stomach, closer to the input end of your stomach. 0:16:37.600 --> 0:16:43.200 That's like the big section, the big fleshy lump party. 0:16:42.520 --> 0:16:47.400 Not so tubular, not so tubular exactly. If it infects there, 0:16:48.040 --> 0:16:51.720 it actually decreases acid production. 0:16:52.800 --> 0:16:57.080 Okay, now I'm confused, I know, right. 0:16:57.600 --> 0:16:58.080 So H. 0:16:58.160 --> 0:17:00.800 Pylori, if it infects higher up in the body of 0:17:00.840 --> 0:17:05.280 your stomach, it actually tends to lead to acid hypo secretion, 0:17:05.760 --> 0:17:13.000 less acid secretion, which increases inflammation because the cells are 0:17:13.080 --> 0:17:17.960 invading in that portion of your stomach and they're directly 0:17:18.080 --> 0:17:22.240 causing inflammation. So it's not the acid itself that's causing 0:17:22.280 --> 0:17:24.719 an ulcer like it is in the duodenum. It's the 0:17:24.760 --> 0:17:31.360 bacteria itself causing ulcers in the stomach from the inflammation. Interesting, okay, 0:17:31.840 --> 0:17:34.960 And on top of that, your stomach cells undergo what's 0:17:35.000 --> 0:17:40.080 called intestinal metaplasia, So now your stomach cells look less 0:17:40.160 --> 0:17:44.120 like stomach cells more like intestine cells. They can't handle 0:17:44.400 --> 0:17:47.760 the acid that is there, so that further leads to 0:17:47.880 --> 0:17:53.520 gastric ulcers, and gastric ulcers can lead to gastric cancer. 0:17:53.960 --> 0:17:56.440 Okay, hold on a second, so let me just get 0:17:56.480 --> 0:18:02.120 this straight. Depending on where these bacteria colonize in your stomach, 0:18:02.280 --> 0:18:06.400 it can either make your stomach look more like your 0:18:06.400 --> 0:18:10.600 intestine or your small intestine look more like your stomach. Yes, 0:18:11.160 --> 0:18:12.639 that's bizarre. 0:18:12.880 --> 0:18:17.080 I love it bizarre. It's it is fascinating, and it's 0:18:17.480 --> 0:18:22.040 it's completely different mechanisms, right Like, in one, you're ending 0:18:22.119 --> 0:18:24.480 up with hyper secretion of acid. In one, you're ending 0:18:24.560 --> 0:18:27.479 up with hyposeecretion of acid. In both you end up 0:18:27.480 --> 0:18:31.720 with ulcers, and in one you end up with cancer. 0:18:33.040 --> 0:18:36.800 And that's with the the gas gastric Yeah, okay, so 0:18:37.520 --> 0:18:40.040 can we just do terminology really quickly because I read 0:18:40.359 --> 0:18:44.440 so many different words in front of ulcer. So there's peptic, 0:18:44.480 --> 0:18:48.440 there's duodenal, there's gastric and is peptic just an umbrella 0:18:48.520 --> 0:18:50.679 term for stomach ulcer I believe? 0:18:50.720 --> 0:18:53.480 So yeah, peptic ulcer is peptic ulcer disease is just 0:18:53.600 --> 0:18:57.440 you've got an ulcer somewhere around your stomach. A duodenal 0:18:57.520 --> 0:19:00.200 ulcer is an ulcer in your duodenum, so that's you're 0:19:00.800 --> 0:19:04.199 the first part of your small intestine. Those ulcers have 0:19:04.280 --> 0:19:07.879 a very very very very low risk of ever developing cancer. 0:19:07.920 --> 0:19:10.879 They basically you basically never get cancer in your small 0:19:10.880 --> 0:19:12.280 intestine for whatever reason. 0:19:12.320 --> 0:19:13.080 It's very rare. 0:19:14.560 --> 0:19:17.080 They can erode all the way through and then cause 0:19:17.080 --> 0:19:19.639 massive bleeding, but you don't tend to get cancer in 0:19:19.640 --> 0:19:24.520 your small intestine. Gastric ulcers are an ulcer in your stomach, 0:19:24.600 --> 0:19:28.240 and those do have a pretty high rate of converting 0:19:28.240 --> 0:19:29.440 into gastric cancer. 0:19:29.800 --> 0:19:34.400 Okay, Okay, I think I've finally got that. The location 0:19:34.600 --> 0:19:37.439 and the umbrella turns down. It's a lot of words. 0:19:38.600 --> 0:19:43.120 Yeah, so that's how they cause disease. It's we we 0:19:43.160 --> 0:19:47.399 know very little comparatively about h pylori, more less than 0:19:47.440 --> 0:19:48.880 I expected, quite honestly. 0:19:49.080 --> 0:19:51.560 Well, it's a pretty recent discovery. 0:19:51.720 --> 0:19:52.240 It's true. 0:19:52.400 --> 0:19:56.639 It's true. Okay, So if you are infected and you 0:19:56.680 --> 0:20:00.560 are showing symptoms, like what what are the symptoms or 0:20:00.600 --> 0:20:04.280 signs that you experience if you have peptic ulcers or 0:20:04.440 --> 0:20:08.159 gastritis or whatever else is there a difference between the 0:20:08.240 --> 0:20:09.359 ulcers and the symptoms. 0:20:09.760 --> 0:20:12.879 Yeah, it's a great question. So you can't tell the 0:20:12.920 --> 0:20:17.359 difference between something like gastric cancer and just peptic ulcer 0:20:17.400 --> 0:20:20.520 disease based on symptoms alone, because the symptoms are actually 0:20:20.920 --> 0:20:22.720 very similar, if not exactly the same. 0:20:22.880 --> 0:20:25.600 Oh my god, great, So you could be like, is 0:20:25.640 --> 0:20:28.840 this an ulcer or cancer? WebMD might be right. 0:20:30.160 --> 0:20:33.600 Don't trust WebMD on this. Let me tell you. But 0:20:33.720 --> 0:20:37.560 the symptoms include things like a burning stomach pain. So 0:20:37.600 --> 0:20:40.440 people of peptic ulcer disease might often say they have 0:20:41.280 --> 0:20:42.160 acid reflux. 0:20:42.840 --> 0:20:44.440 Okay, right, So you might have like a. 0:20:44.359 --> 0:20:48.600 Burning in your sort of substernal region. You might have 0:20:48.640 --> 0:20:51.600 a feeling of fullness or a lot of bloating in 0:20:51.640 --> 0:20:56.720 your stomach. You might have nausea or vomiting, especially if 0:20:56.760 --> 0:21:00.159 you're vomiting something like blood that's suggestive of something like 0:21:00.200 --> 0:21:05.119 peptic ulcer disease. Your face looks a little horrified just 0:21:05.200 --> 0:21:05.760 the concept. 0:21:05.880 --> 0:21:08.280 Yeah, vomiting blood, Nope. Yeah. 0:21:08.280 --> 0:21:10.760 And then the other things that we get really concerned 0:21:10.760 --> 0:21:13.880 about if you have these type of signs are things 0:21:13.920 --> 0:21:17.080 like unexplained weight loss because maybe you're not eating as 0:21:17.160 --> 0:21:21.160 much because you have pain, when you eat so unexplained 0:21:21.160 --> 0:21:25.000 weight loss or appetite changes, and then dark stools, because 0:21:25.040 --> 0:21:27.680 what can actually happen is that those ulcers can cause 0:21:27.680 --> 0:21:30.760 bleeding and if you're not vomiting up the blood, it'll 0:21:30.880 --> 0:21:33.719 travel through your gastrointestinal tract and by the time it 0:21:33.760 --> 0:21:36.639 comes out in the stool, it doesn't look like blood anymore. 0:21:36.680 --> 0:21:39.560 It just looks like very very dark stools. So if 0:21:39.560 --> 0:21:42.520 you've ever had a doctor ask you, are your stools dark, 0:21:42.880 --> 0:21:45.800 that's what they're asking about, is their secret blood. 0:21:47.119 --> 0:21:48.240 Did you eat beats? No? 0:21:50.440 --> 0:21:54.680 Yeah, that's is a little different the episode of Portlandia 0:21:54.760 --> 0:21:55.280 where they're. 0:21:55.840 --> 0:22:01.480 It's beats with Jeff Yes, is it beats? Okay? 0:22:01.520 --> 0:22:01.920 Anyway? 0:22:02.200 --> 0:22:04.280 Yep? Anyway. Yeah. 0:22:04.320 --> 0:22:08.600 So those are the symptoms, and you can't necessarily distinguish, 0:22:08.880 --> 0:22:12.680 especially those more severe symptoms of peptic ulcer disease from 0:22:12.720 --> 0:22:15.600 gastric cancer, just based on symptoms. So we do what's 0:22:15.600 --> 0:22:17.720 called an endoscopy, which is where they put a camera 0:22:17.760 --> 0:22:19.600 down into your stomach and they take a look at 0:22:19.600 --> 0:22:22.119 the ulcer. If they find an ulcer, then they can 0:22:22.160 --> 0:22:24.080 biopsi it and then figure out what's going on. 0:22:25.040 --> 0:22:27.639 Okay. Is that usually the first step is an endoscopy 0:22:27.680 --> 0:22:29.560 if you have symptoms, or do they do the breath 0:22:29.560 --> 0:22:30.960 test or what so. 0:22:31.000 --> 0:22:33.840 The urease breath test is a test to check for H. 0:22:33.880 --> 0:22:38.240 Pylori infection, and yes, you can absolutely do that. So 0:22:38.280 --> 0:22:40.600 if you go to a doctor with symptoms of peptic 0:22:40.680 --> 0:22:43.119 ulcer disease, it's very likely that they'll do a uiase 0:22:43.160 --> 0:22:43.720 breath test. 0:22:44.640 --> 0:22:45.560 The other thing you can. 0:22:45.400 --> 0:22:46.560 Do is treat the H. 0:22:46.640 --> 0:22:50.240 Pylori so it is treatable. It's a little difficult to treat. 0:22:51.520 --> 0:22:54.280 There's three different medications that you give. First as a 0:22:54.320 --> 0:22:59.640 proton pump inhibitor, which decreases acid production. Second is two 0:22:59.640 --> 0:23:02.360 different antibiotics and you take these for quite a long time. 0:23:02.400 --> 0:23:05.160 I think it's at least a few weeks of antibiotic 0:23:05.240 --> 0:23:08.280 treatment to clear that H. Pylori infection. And if your 0:23:08.320 --> 0:23:12.159 symptoms go away, then it was all from the H. 0:23:12.240 --> 0:23:14.840 Pylori And if they don't, then they'll probably do follow 0:23:14.880 --> 0:23:15.359 up treatment. 0:23:16.040 --> 0:23:19.920 So yeah, that's that's H. Pylori infection. 0:23:20.640 --> 0:23:21.480 How interesting? 0:23:22.080 --> 0:23:23.920 Yeah, wow, fun little bug. 0:23:23.960 --> 0:23:27.440 I think it's definitely got a lot of tricks of 0:23:27.520 --> 0:23:27.920 its sleeve. 0:23:28.359 --> 0:23:30.080 It's got a lot of tricks and we there's so 0:23:30.200 --> 0:23:33.119 many that we don't know yet, which I think is 0:23:33.200 --> 0:23:39.360 so fun and interesting. Yeah, so, Aaron, how'd we get here? 0:23:39.720 --> 0:23:40.919 Where'd this thing come from? 0:23:41.560 --> 0:23:44.560 Oh? I can't wait to tell you good But first 0:23:44.680 --> 0:24:13.359 a little break. I feel like there's this notion of 0:24:13.720 --> 0:24:17.760 ulcers and gastritis as being this modern disease brought on 0:24:17.920 --> 0:24:22.600 by this modern stressful work environment, acidic foods, lack of sleep, 0:24:22.760 --> 0:24:27.920 et cetera. But guess what what it's not. It's old. 0:24:28.359 --> 0:24:29.399 It's really old. 0:24:29.560 --> 0:24:31.760 We've always had ulcers. 0:24:31.600 --> 0:24:34.880 Actually kind of. So humans in H. Pylori have been 0:24:34.920 --> 0:24:39.359 together for thousands of years, so since before humans left 0:24:39.400 --> 0:24:43.240 East Africa over fifty thousand to seventy thousand years ago. 0:24:43.720 --> 0:24:47.199 Holy cow. Yeah, so, which explains why there's such a 0:24:47.280 --> 0:24:50.439 huge proportion of the population that's infected. It's really just 0:24:50.520 --> 0:24:54.200 been with us. So researchers can actually see the traces 0:24:54.240 --> 0:24:58.200 of different waves of human migration in the genetic diversity 0:24:58.320 --> 0:25:01.200 of these H. Pylori strains. Stop it. 0:25:01.840 --> 0:25:04.120 Yes, I love it when we get to talk about 0:25:04.200 --> 0:25:06.320 human migration because of disease. 0:25:06.720 --> 0:25:10.000 I know, it's really cool. So basically, as a general 0:25:10.080 --> 0:25:13.960 rule with this, the most genetically diverse H. Pylori strains 0:25:13.960 --> 0:25:17.800 are associated with the oldest migrations and the source population 0:25:17.960 --> 0:25:22.639 in East Africa when humans migrated out, and then the 0:25:22.680 --> 0:25:26.840 genetic diversity decreases with each migration, and then distance and 0:25:26.880 --> 0:25:29.720 so on. So yeah, isn't that cool? 0:25:30.000 --> 0:25:30.320 Yeah? 0:25:30.359 --> 0:25:31.719 I love it all right. 0:25:31.760 --> 0:25:35.240 So we've got this evolutionary evidence of early human and h. 0:25:35.320 --> 0:25:39.560 Pylori association, and we've also got ancient writings about ulcers 0:25:39.560 --> 0:25:44.639 and gastritis. So gastric symptoms have been recorded for millennia, 0:25:45.160 --> 0:25:49.000 dating back, of course to Hippocrates. Where would we be 0:25:49.280 --> 0:25:50.400 without Hippocrates? 0:25:50.840 --> 0:25:51.280 Nowhere? 0:25:51.520 --> 0:25:54.520 And on an episode of this podcast, will kill You Nope. 0:25:54.680 --> 0:26:00.199 So yeah, So Hippocrates describe epigastric burning like indigestion and 0:26:00.320 --> 0:26:04.520 air swallowing, both of which are symptoms of gastritis. 0:26:04.640 --> 0:26:06.680 I think air swallowing just burping. 0:26:07.240 --> 0:26:11.440 Air swallowing is what was written. Weird, Maybe it's just burping, 0:26:11.480 --> 0:26:15.920 I don't know. And around the same time as Hippocrates, 0:26:16.000 --> 0:26:18.520 there is an inscription carved on a pillar at the 0:26:18.560 --> 0:26:22.520 temple of Asclepius at Epidaurus that might be describing how 0:26:22.560 --> 0:26:27.879 to perform surgery on a gastric ulcer. Ooh, quote a 0:26:27.920 --> 0:26:31.119 man with an ulcer in his stomach. He incubated and 0:26:31.160 --> 0:26:34.680 saw a vision. The gods seemed to order his followers 0:26:34.720 --> 0:26:38.000 to seize and hold him that he might insize his stomach. 0:26:38.680 --> 0:26:40.960 So he fled, but they caught and tied him to 0:26:41.000 --> 0:26:44.840 the door knocker. Then Asclepius opened his stomach, cut out 0:26:44.880 --> 0:26:48.080 the ulcer, sewed him up again, and loosed his bonds. 0:26:48.720 --> 0:26:51.080 He went away whole, but the chamber was covered with 0:26:51.119 --> 0:26:59.959 his blood on Earth one star. That's just inscribe. 0:27:00.000 --> 0:27:02.400 We've done a pillar at a temple. Yeah, it does 0:27:02.400 --> 0:27:05.280 a story of we're gonna do surgery on this guy 0:27:05.359 --> 0:27:06.320 against his will. 0:27:06.840 --> 0:27:08.480 I don't know, but we should add that to our 0:27:08.640 --> 0:27:13.159 like take a picture of this and also our personal 0:27:13.200 --> 0:27:18.639 vacation list. Oh yes, yeah, so we also in addition 0:27:18.680 --> 0:27:22.920 to this pillar, we also have a mummy dating from 0:27:22.920 --> 0:27:25.280 a little bit after this, around one hundred and sixty 0:27:25.320 --> 0:27:29.600 seven BCE from the Western Han dynasty that appears to 0:27:29.680 --> 0:27:32.680 have a peptic ulcer. We don't know if it was 0:27:32.760 --> 0:27:36.119 caused by H. Pylori, but yeah, definitely seems possible in 0:27:36.160 --> 0:27:38.200 a mummy. Cool. 0:27:38.800 --> 0:27:41.320 That's so cool that mummies are preserved so well that 0:27:41.400 --> 0:27:43.640 you could see something like that in the tissue. 0:27:44.080 --> 0:27:47.680 I know, huh. So about a thousand years after that 0:27:47.920 --> 0:27:51.640 we get a bit more specific when even Senna Avicenna 0:27:51.960 --> 0:27:54.840 wrote about how some of these painful or uncomfortable symptoms 0:27:54.880 --> 0:27:58.359 appear after you eat. He even went as far to 0:27:58.440 --> 0:28:02.080 suggest that they pay heartburn and thirst felt by some 0:28:02.119 --> 0:28:05.760 people were all caused by a gastric ulcer. Okay, then 0:28:06.000 --> 0:28:09.560 in the late fifteen hundreds, so about five hundred years 0:28:09.560 --> 0:28:14.400 after Avicenna described this, the first gastric ulcer was definitely 0:28:14.400 --> 0:28:18.760 described by the Italian physician Marcelo Donatti. During this time, 0:28:18.840 --> 0:28:23.400 anatomical descriptions from dissections of human cadavers were getting super popular, 0:28:23.920 --> 0:28:25.879 and so people were starting to take a note of 0:28:25.920 --> 0:28:29.600 the inflammation and ulceration of the mucosa in their cadavers. 0:28:31.240 --> 0:28:34.919 I didn't see anything about numbers through the ages in 0:28:34.960 --> 0:28:38.400 regards to the prevalence of gastric ulcers. I think that 0:28:38.440 --> 0:28:40.959 would be a really hard thing to estimate, and especially 0:28:41.040 --> 0:28:46.400 since it's been with humans for since humans have been humans. Basically, yeah, 0:28:46.440 --> 0:28:49.600 it was probably pretty prevalent at least, and also we 0:28:50.080 --> 0:28:52.240 can guess that it was pretty prevalent based on how 0:28:52.240 --> 0:28:54.480 many descriptions there were of it and how much people 0:28:54.480 --> 0:28:58.320 started to pay attention to it as cadaver dissection was 0:28:58.560 --> 0:29:03.080 a lot more popular, and then came the sixteen hundreds. 0:29:03.360 --> 0:29:07.000 Microscopy was developed and popularized by a couple of big names, 0:29:07.480 --> 0:29:10.920 but probably the biggest name is Anthony van Lewin Hook 0:29:11.160 --> 0:29:15.680 Layman Hook. The impact of his technology and also how 0:29:15.760 --> 0:29:18.160 far it has come today really should get an episode 0:29:18.200 --> 0:29:20.640 of its own. Wouldn't that be fun? Yeah? For sure, 0:29:20.640 --> 0:29:23.920 I love the history of microscopy. But the important thing 0:29:24.120 --> 0:29:27.360 is that microscopes allowed people to see this whole new 0:29:27.400 --> 0:29:32.560 world which had been invisible to them up to this point. Essentially, 0:29:32.640 --> 0:29:36.080 this led to the field of microbiology and molecular biology 0:29:36.680 --> 0:29:40.000 because people could finally start understanding how the pieces that 0:29:40.160 --> 0:29:44.479 made up living organisms fit together. Bacteria were described and 0:29:44.520 --> 0:29:48.280 started being blamed rightfully so for some in some cases, 0:29:48.360 --> 0:29:52.080 for many diseases, and people started sticking everything they could 0:29:52.080 --> 0:29:55.840 find under these new lenses, and stomach tissue or stomach 0:29:55.880 --> 0:30:01.080 contents was no exception. And because bacteria live on basically 0:30:01.200 --> 0:30:05.000 every surface ever, of course, stomach contents look to be 0:30:05.160 --> 0:30:09.520 chock full of bacteria. Some of these microscope lookers became 0:30:09.800 --> 0:30:13.000 convinced that the bacteria were the cause of gastric inflammation 0:30:13.080 --> 0:30:15.959 and disease, and a couple of these people had identified 0:30:15.960 --> 0:30:19.640 bacterial colonies in gastric ulcers and in the surrounding mucosa 0:30:20.440 --> 0:30:23.200 and went so far as to say that these bacteria 0:30:23.440 --> 0:30:28.920 were the cause of ulcers. That was in eighteen seventy five. Whoa, yeah, 0:30:29.040 --> 0:30:31.080 they were like, oh, there's bacteria here. It seems to 0:30:31.120 --> 0:30:33.800 be in aligning, it seems to be associated with inflammation. 0:30:35.520 --> 0:30:38.280 This is what causes the ulcers. So then what happened? 0:30:38.280 --> 0:30:40.800 Why did it take us another one hundred plus years 0:30:40.840 --> 0:30:41.920 to figure it out? 0:30:42.200 --> 0:30:45.480 Okay, well I'll get to that, but yeah, it did 0:30:45.800 --> 0:30:49.440 kind of. The link didn't necessarily become forgotten, but it 0:30:49.480 --> 0:30:53.440 definitely was not as popular as some of the other 0:30:53.840 --> 0:30:58.720 leading hypotheses. Interesting, and so the late eighteen hundreds did 0:30:58.760 --> 0:31:02.960 see some other progress guarding bacteria and peptic ulcers and gastritis. 0:31:03.560 --> 0:31:07.960 For instance, the pathologist Arnold C. Klebs, who was son 0:31:08.080 --> 0:31:11.680 of the Clubs for whom Clubciella was named, Yes, he 0:31:11.800 --> 0:31:14.920 spotted a bacillis in the gastric glands, which he noted 0:31:14.920 --> 0:31:18.080 were inflamed. And so this could be actually the first 0:31:18.120 --> 0:31:22.360 sighting of H. Pylori infectious gastritis in humans. And then 0:31:22.400 --> 0:31:27.360 there was an Italian anatomus named Bizo zero who reported 0:31:27.360 --> 0:31:30.800 his findings of a Spirokeet like organism in the stomach 0:31:30.880 --> 0:31:34.400 lining of several dogs that he studied, which was probably 0:31:34.440 --> 0:31:38.560 a Helicobacter species. And remember those two guys who I 0:31:38.680 --> 0:31:42.640 just mentioned that first declared this link between gastric ulcers 0:31:42.640 --> 0:31:46.640 and bacterial infections. So even though mostly everyone else had 0:31:46.680 --> 0:31:49.800 dropped that concept, they were still convinced. And so by 0:31:49.800 --> 0:31:52.440 eighteen eighty eight a ton of progress had been made 0:31:52.440 --> 0:31:56.000 in identifying different bacterial species and the diseases they caused 0:31:56.160 --> 0:32:00.120 just in general. So these guys started picking candidate microbs 0:32:00.240 --> 0:32:03.560 such as Staphoreus and Strep to see if they caused 0:32:03.640 --> 0:32:06.880 ulcers when injected into the stomach of various lab animals, 0:32:07.400 --> 0:32:10.560 and no surprise, they did. But that was sort of 0:32:10.560 --> 0:32:13.480 a problem, right, because if all of these different species 0:32:13.520 --> 0:32:17.240 could cause gastric ulcers, how do you distinguish between the 0:32:17.320 --> 0:32:20.400 types of ulcers and between whether this bacteria causes an 0:32:20.480 --> 0:32:26.240 ulcer or whether they're just general ulcer causing bacteria. After 0:32:26.560 --> 0:32:30.080 Latoul was able to induce ulcers, in his guinea pigs. 0:32:30.960 --> 0:32:33.480 Other people started to get interested and found that a 0:32:33.480 --> 0:32:37.360 whole bunch of bacterial species could lead to gastri duodenal ulcers. 0:32:38.280 --> 0:32:40.480 But there was still so much to be figured out, 0:32:40.720 --> 0:32:44.760 and gastric ulcers were a tricky business because, like I said, 0:32:44.800 --> 0:32:47.840 you can get ulceration with many different diseases, and you 0:32:47.840 --> 0:32:51.719 could induce it with many different bacterial species. So how 0:32:51.760 --> 0:32:56.600 do you pinpoint exactly which species causes ulcers for sure, 0:32:56.680 --> 0:32:59.520 rather than just these opportunistic infections. 0:32:59.200 --> 0:33:02.520 Right, which does it in real life versus just if 0:33:02.520 --> 0:33:04.480 you injected in the lab exactly? 0:33:04.840 --> 0:33:05.880 Yeah? 0:33:05.960 --> 0:33:09.680 And so really what became more popular in terms of 0:33:09.960 --> 0:33:14.280 why gastritis and peptic ulcers exist was that excess acid 0:33:15.240 --> 0:33:17.480 that was it, and that could be triggered by the 0:33:17.680 --> 0:33:22.040 ingestion of foods or drinks high in acidity, stress, et cetera. 0:33:22.960 --> 0:33:26.680 And this explanation resolved a few things that were maybe 0:33:26.760 --> 0:33:30.280 a bit more difficult to align with the bacteria hypothesis. 0:33:30.880 --> 0:33:34.200 So often people who experienced ulcers didn't have symptoms all 0:33:34.200 --> 0:33:36.080 of the time. They had flare ups, and then they 0:33:36.080 --> 0:33:39.200 would resolve after cutting back on certain foods or taking 0:33:39.240 --> 0:33:42.240 lots of anti acids, and so during this time, it 0:33:42.280 --> 0:33:45.800 was basically conventional wisdom that bacteria couldn't survive in the 0:33:45.880 --> 0:33:49.600 high acidity environment of the stomach, so if bacteria were 0:33:49.600 --> 0:33:52.640 found in the lesions, they were probably from ingested food 0:33:53.480 --> 0:33:56.520 or the stomach was weakened enough to allow for these 0:33:56.560 --> 0:34:00.440 opportunistic invaders. So it was like they were second and dairy. 0:34:00.560 --> 0:34:04.320 The ulcers were the primary rather than yeah interesting. 0:34:04.240 --> 0:34:08.040 Yeah, And it wasn't so much that people weren't finding 0:34:08.160 --> 0:34:12.640 h pylorian stomach tissue. A camplobacter like or curved rod 0:34:12.680 --> 0:34:15.720 bacteria had been reported as part of the gastric flora 0:34:15.800 --> 0:34:19.759 for decades, but no one had had much luck in 0:34:19.760 --> 0:34:23.960 investigating them. In the nineteen fifties, someone named Edie Palmer 0:34:24.480 --> 0:34:27.560 decided to take a closer look, and he concluded that 0:34:27.600 --> 0:34:31.760 they were just normal commensals of the mouth. These curved 0:34:31.840 --> 0:34:35.800 rod bacteria were basically cast aside as unimportant, which really 0:34:36.120 --> 0:34:38.960 kind of held back the field, probably for a few decades. 0:34:40.120 --> 0:34:43.040 All right, let's take stock of where and when we are. 0:34:43.880 --> 0:34:47.640 It's the early nineteen eighties, and the excess acid hypothesis 0:34:47.840 --> 0:34:50.799 was the prevailing one, despite some reports in the late 0:34:50.840 --> 0:34:58.799 seventies of epidemic gastritis with hypocorhydria, so low acid acido 0:35:00.280 --> 0:35:04.560 and findings of Gram negative bacteria in association with acute gastritis. 0:35:04.760 --> 0:35:06.680 Oh my gosh, I'm getting really excited. 0:35:07.640 --> 0:35:11.279 So the bacteria hypothesis is still hanging in there, and 0:35:11.360 --> 0:35:14.920 one of its proponents is an Australian pathologist named Robin 0:35:14.960 --> 0:35:17.960 Warren who was working at the Royal Perth Hospital in 0:35:18.000 --> 0:35:22.720 Western Australia. Warren had a hunch that the gastric ulcers 0:35:22.719 --> 0:35:26.080 he had seen in patients over the years had bacterial origins. 0:35:26.880 --> 0:35:29.000 In nineteen eighty one, he had written a letter to 0:35:29.040 --> 0:35:32.560 another doctor asking whether there were any gastra entrologists that 0:35:32.640 --> 0:35:35.960 wanted to work on uncovering this mystery with him, And 0:35:36.040 --> 0:35:38.839 this doctor just happened to show this letter to a 0:35:38.880 --> 0:35:43.800 young physician named Barry Marshall Berry who had just started 0:35:43.800 --> 0:35:47.040 his gaster entrology fellowship term where he would have to 0:35:47.040 --> 0:35:48.759 come up with a research project to do. 0:35:49.480 --> 0:35:51.440 Oh my gosh, can. 0:35:51.640 --> 0:35:55.840 Even imagine be Yeah, that's my first year of fellowship 0:35:55.840 --> 0:35:56.920 by nine a project. 0:35:57.000 --> 0:36:00.000 Oh this sounds great. And then it's h by Laurie. 0:36:00.200 --> 0:36:05.719 Oh yeah, gosh, it's it would be incredible, And I 0:36:05.719 --> 0:36:08.360 mean I think it was like so from all of 0:36:08.360 --> 0:36:11.880 the different things that I read, their personalities were perfectly 0:36:11.920 --> 0:36:14.720 suited to one another and to solving this problem. 0:36:15.239 --> 0:36:18.719 Because you have Robin Warren, who seemed from what I 0:36:18.760 --> 0:36:23.000 read to be very methodical, very detail oriented, very sort 0:36:23.040 --> 0:36:27.359 of like step one, step two, step three. And then 0:36:27.840 --> 0:36:30.040 on the flip side of that, you have this young, 0:36:30.680 --> 0:36:35.239 like sort of energetic, impatient guy, Bary Marshall. And so 0:36:35.280 --> 0:36:37.799 they balanced each other out really well, and they were 0:36:37.800 --> 0:36:43.280 both I think most importantly iconoclastic. They wanted to fight 0:36:43.360 --> 0:36:47.560 for this hypothesis because I think I quote or something, well, 0:36:47.560 --> 0:36:50.719 I'm not going to quote actually, because I think that 0:36:51.200 --> 0:36:55.799 for Robin Warren, he was most fascinated by the fact 0:36:55.840 --> 0:37:00.800 that these bacteria were somewhere they shouldn't be. Yeah, and 0:37:00.840 --> 0:37:04.760 Barry Marshall wanted to wanted this opportunity to prove everyone 0:37:04.760 --> 0:37:07.759 else wrong. Of course, So it was just the perfect 0:37:07.880 --> 0:37:09.200 combination of things. 0:37:09.480 --> 0:37:10.080 I love it. 0:37:10.400 --> 0:37:15.560 Yeah, Okay, Marshall decides to join this project, and neither 0:37:15.640 --> 0:37:20.960 of them had strict backgrounds in microbiology, so they decided to, 0:37:21.440 --> 0:37:23.719 you know, say, who cares, We're just going to try 0:37:23.719 --> 0:37:26.200 to do this. Anyway, we're going to isolate and culture 0:37:26.200 --> 0:37:30.160 this Camplo bacter like bacterium that Warren had found in 0:37:30.200 --> 0:37:33.839 so many of his patients. I also wonder a bit 0:37:34.760 --> 0:37:40.719 about whether not having that microbiology or gastroentrology specific background 0:37:40.760 --> 0:37:43.480 probably helped them a bit too, sort of not having 0:37:43.480 --> 0:37:48.320 those preconceived notions or the dogma that are so pounded 0:37:48.360 --> 0:37:51.000 into you during particularly research training. 0:37:51.320 --> 0:37:55.160 Yeah, you haven't already been sort of indoctrinated or ingrained 0:37:55.200 --> 0:37:58.880 on any one specific belief, so you have this option 0:37:59.080 --> 0:38:02.080 to just explore or all these different possibilities. 0:38:02.200 --> 0:38:05.040 Yeah. H thinking outside the box is much easier when 0:38:05.040 --> 0:38:08.640 you don't know the shape of the box that you're in. Totally. Yeah. 0:38:08.680 --> 0:38:12.239 In any case, they started their microbe hunt not necessarily 0:38:12.280 --> 0:38:16.279 starting out saying that these bacteria caused ulcers, but more, hey, 0:38:16.360 --> 0:38:18.640 look what we found. It's a new bacterial species that 0:38:18.680 --> 0:38:20.400 can survive in the gut, and maybe it has some 0:38:20.480 --> 0:38:24.359 links to gastritis and inflammation. But saying you're going to 0:38:24.400 --> 0:38:28.759 isolate and culture and undescribed bacterium is quite different than 0:38:28.840 --> 0:38:32.759 actually doing it. As they both learned, culturing something new 0:38:32.800 --> 0:38:35.520 can be a bit of a tricky game. You have 0:38:35.600 --> 0:38:39.040 to figure out the or know the right culture formula 0:38:39.160 --> 0:38:42.400 to use and the right settings for optimal growth. And 0:38:42.440 --> 0:38:46.680 when something is as extreme as something that can live 0:38:46.760 --> 0:38:52.920 in your stomach's acidic environment, it's a difficult place to start. Yeah, So, 0:38:53.080 --> 0:38:58.040 after months of trying to culture isolates from gastritis patients 0:38:58.040 --> 0:39:01.440 and not getting anything, they may have started to lose 0:39:01.480 --> 0:39:05.719 a little hope. But then a fortunate accident occurred, as 0:39:05.800 --> 0:39:10.000 these things do, seemed to happen. It turns out that 0:39:10.080 --> 0:39:13.080 the lab tech who was responsible for culturing the isolates 0:39:13.120 --> 0:39:16.840 and checking on those cultures was throwing away the plates 0:39:17.280 --> 0:39:21.400 or broth after two days. This was happening at a hospital. 0:39:21.600 --> 0:39:25.719 Hospital is busy place. It tends to be chaotic. There's 0:39:25.760 --> 0:39:28.520 a lot of other epidemics and things going through the lab, 0:39:28.560 --> 0:39:32.200 so there really wasn't room for dozens of stomach bacterial 0:39:32.239 --> 0:39:36.759 culture plates to just hang around. But on a particularly 0:39:36.800 --> 0:39:41.440 busy weekend, Easter weekend in fact, the tech didn't have 0:39:41.760 --> 0:39:43.960 enough time to look at the plates after the usual 0:39:44.000 --> 0:39:47.240 two days, so he left them over the weekend until Tuesday, 0:39:48.200 --> 0:39:52.200 five days after the biopsy, and when he went back 0:39:52.239 --> 0:39:55.960 to check on the cultures, boom colonies were present, they 0:39:56.000 --> 0:39:58.520 were just slow. They were just slow. 0:40:00.040 --> 0:40:01.440 They're like, give me some time. 0:40:01.840 --> 0:40:07.040 Yeah, I'm growing here. So these bacteria had probably been 0:40:07.080 --> 0:40:09.920 in all, or at least the vast majority of those samples, 0:40:10.000 --> 0:40:12.560 but they just needed a little bit longer to incubate. 0:40:13.239 --> 0:40:19.120 Oh So, now that Marshall and Warren could culture these bacteria, 0:40:19.280 --> 0:40:21.719 they could do so many things that could find out 0:40:21.760 --> 0:40:25.160 what antibiotics could be used against it, try to develop 0:40:25.160 --> 0:40:27.839 an animal model of infection, try to find out what 0:40:27.880 --> 0:40:31.239 these bacteria were related to, and most importantly, try to 0:40:31.239 --> 0:40:35.200 find out what these bacteria did in the stomach. So 0:40:35.239 --> 0:40:38.600 they decided to test one hundred patients to see if 0:40:38.600 --> 0:40:41.120 the bacterium was present and to look for patterns of 0:40:41.120 --> 0:40:44.720 infection or any sort of disease state, and they found 0:40:45.000 --> 0:40:50.600 that all patients with duodenal ulcers had the bacterium. Not conclusive, 0:40:50.680 --> 0:40:55.480 but definitely suggestive. Marshall and Warren then started to develop 0:40:55.520 --> 0:40:59.919 a hypothesis these bacteria cause gastritis, and then gastritis leads 0:40:59.920 --> 0:41:03.840 to ulcers. People could have recurrent ulcers because their immune 0:41:03.840 --> 0:41:07.480 system would be stronger at various points or whatever, but 0:41:07.560 --> 0:41:09.920 the bacteria would always be there, so it never went 0:41:09.960 --> 0:41:14.120 away completely, and this also explained why earlier trials of 0:41:14.160 --> 0:41:18.000 physicians treating their gastrite as patients with antibiotics saw a 0:41:18.040 --> 0:41:23.239 reduction in acid and symptoms. They tried to publish some 0:41:23.360 --> 0:41:26.839 of their findings in The Lancet, in a letter and 0:41:26.920 --> 0:41:29.360 as an abstract at an annual meeting of the gastra 0:41:29.480 --> 0:41:36.719 Entroological Society of Australia, but faced difficulty and rejection. Yeah, 0:41:37.000 --> 0:41:39.520 the Lancet couldn't get reviewers to agree on whether their 0:41:39.520 --> 0:41:43.279 findings were important or whether their conclusions were true, and 0:41:43.320 --> 0:41:47.880 the gastor Interrological Society of Australia just flatly completely rejected 0:41:47.920 --> 0:41:51.759 their abstract. They were like, we received sixty seven submissions 0:41:51.760 --> 0:41:55.040 and we could only accept fifty six this year. We're sorry, 0:41:55.120 --> 0:41:59.719 we couldn't get your those are the numbers. Why did 0:41:59.719 --> 0:42:01.640 they have I have to point out how many there 0:42:01.680 --> 0:42:04.920 were and why fifty six? I think it just seems 0:42:05.040 --> 0:42:08.280 unnecessarily hard not just put up a couple extra boards 0:42:08.320 --> 0:42:09.480 to tack your poster on. 0:42:09.640 --> 0:42:10.759 I mean goodness, I. 0:42:10.760 --> 0:42:17.520 Know, right, it seems seems rude. So the bacteria hypothesis 0:42:17.600 --> 0:42:19.759 seemed to fit with so much of what was known 0:42:19.800 --> 0:42:22.960 about ulcers but this concept met with a ton of 0:42:23.000 --> 0:42:26.600 resistance among doctors, many of whom would dismiss the bacteria 0:42:26.600 --> 0:42:30.560 as being opportunistic, only able to establish after the stomach 0:42:30.600 --> 0:42:33.279 was already weakened, and they would argue that if this 0:42:33.400 --> 0:42:36.279 bacterium actually caused disease, the link would have been made 0:42:36.320 --> 0:42:40.040 a long time ago. It's really silly, yeah, I mean, 0:42:40.080 --> 0:42:42.880 after all, it had been observed in the stomach for ages, 0:42:43.400 --> 0:42:46.520 so it should have been known by now. Things weren't 0:42:46.520 --> 0:42:48.400 always civil, and there was a lot of rude or 0:42:48.400 --> 0:42:52.160 dismissive comments made behind Marshall and Warren's backs, and many 0:42:52.239 --> 0:42:56.080 did not take them seriously as not having official microbiology 0:42:56.160 --> 0:43:01.560 or gastentrology credentials. Then, the ulcer drug business, which was 0:43:01.560 --> 0:43:04.360 one of the biggest in the nineteen eighties, wasn't exactly 0:43:04.400 --> 0:43:07.759 in support of this notion. Something I never thought of 0:43:07.800 --> 0:43:11.719 before reading this article. People with gastritis or ulcers were 0:43:11.719 --> 0:43:14.920 spending a little bit of money every day on the drugs, 0:43:15.440 --> 0:43:18.840 and they were often long term, if not lifetime customers. 0:43:19.600 --> 0:43:21.919 So if you could cure those conditions with the course 0:43:21.920 --> 0:43:26.520 of antibiotics, boom, the industry would be devastated. Yeah, so 0:43:26.600 --> 0:43:28.759 they spent a bunch of money doing research trying to 0:43:28.840 --> 0:43:33.239 prove that ulcers were not caused by bacteria. Shocking right. 0:43:34.480 --> 0:43:37.279 Even though the research was sound, Marshall and Warren had 0:43:37.320 --> 0:43:40.320 to demonstrate the cause and effect of the bacteria and ulcer. 0:43:40.920 --> 0:43:44.440 That the bacteria caused gastritis and ulcers, not that the 0:43:44.520 --> 0:43:47.800 ulcers paved the way for the bacteria, but they couldn't 0:43:47.800 --> 0:43:51.759 get the bacteria to infect any animal models. So, like 0:43:51.800 --> 0:43:53.880 you heard in our first hand account at the beginning 0:43:53.920 --> 0:43:57.040 of the episode, Barry Marshall took it upon himself to 0:43:57.080 --> 0:43:59.680 take a swig of the bacterial culture from a sixty 0:43:59.680 --> 0:44:04.120 six year old, non ulcered, dyspeptic man. After first establishing 0:44:04.160 --> 0:44:09.040 Marshall himself had no gastric ulceration or inflammation, within less 0:44:09.080 --> 0:44:12.719 than two weeks all of those symptoms appeared, and the 0:44:12.760 --> 0:44:15.960 final confirmation came in the form of an endoscope. The 0:44:16.000 --> 0:44:18.480 infection seemed to more or less resolve on its own 0:44:18.560 --> 0:44:22.719 for Marshall, but the putrid breath that's characteristic of this 0:44:22.840 --> 0:44:26.680 disease remained. So his wife was like, if you don't 0:44:26.719 --> 0:44:29.440 take antibiotics to get rid of this, you have to 0:44:29.520 --> 0:44:34.560 leave the house. So he took. He took antibiotics and 0:44:34.560 --> 0:44:38.440 got rid of it. But it worked. So it worked, 0:44:38.719 --> 0:44:41.960 and so Marshall's we have an end of two actually, 0:44:42.040 --> 0:44:43.759 or at least of two that I could find. So 0:44:44.040 --> 0:44:48.000 Marshall's self inaculation was followed up by another Australian guy 0:44:48.080 --> 0:44:49.440 named Morris who did the same. 0:44:49.800 --> 0:44:54.440 My only Australians. They're all just just like Steve Irwin. 0:44:54.520 --> 0:44:55.680 They're like, I'm just gonna go. 0:44:55.800 --> 0:45:01.160 For it, and progress has been made. Poor guy was 0:45:01.160 --> 0:45:04.240 not as fortunate as Marshall because it took him five 0:45:04.360 --> 0:45:07.280 years for his gas stritis to resolve, even with treatment. 0:45:08.320 --> 0:45:12.960 So don't try this at home, no, do not. Eventually 0:45:13.000 --> 0:45:16.480 people started coming around to the idea, especially in Australia, 0:45:16.520 --> 0:45:19.279 and doctors started to use antibiotics to treat patients they 0:45:19.320 --> 0:45:22.799 would have otherwise done surgery on to remove part of 0:45:22.840 --> 0:45:27.319 the stomach or the intestine. Yeah, of course they saw 0:45:27.400 --> 0:45:30.680 positive results, but other places were a lot slower to 0:45:30.719 --> 0:45:33.360 try out the treatment. And that's not surprising, Like I 0:45:33.360 --> 0:45:36.520 can't really fault them for that. Giving antibiotics willy nilly 0:45:36.719 --> 0:45:39.000 is not a good idea, even if you have strong 0:45:39.000 --> 0:45:41.680 suspicions they might work. And so the study had to 0:45:41.719 --> 0:45:45.480 be repeated there at all over with the drugs available, 0:45:46.160 --> 0:45:48.920 and ideally using a double blind trial where both those 0:45:48.960 --> 0:45:51.600 administering the drugs and those and those getting the drugs 0:45:51.640 --> 0:45:55.360 didn't know whether they were giving slash, being given treatment 0:45:55.440 --> 0:46:00.120 or placebo. Right, and the results were clear gastritis and 0:46:00.200 --> 0:46:04.160 ulcers could be healed by antibiotics. It became the guideline 0:46:04.160 --> 0:46:06.759 for treatment in many places, and I can imagine it 0:46:06.840 --> 0:46:09.360 must have felt really good to have that sort of vindication, 0:46:09.800 --> 0:46:13.800 even if it came with a several year delay. Barry 0:46:13.840 --> 0:46:16.920 Marshall wasn't done yet though. He helped to develop the 0:46:16.960 --> 0:46:21.080 breath test for h pylori, which was Yeah, and that 0:46:21.160 --> 0:46:23.440 was a really wonderful because that meant that people didn't 0:46:23.480 --> 0:46:27.240 necessarily have to have endoscopies, which were uncomfortable and cost 0:46:27.280 --> 0:46:30.320 a lot of money, particularly if you're in the US 0:46:30.440 --> 0:46:33.080 and you have to pay for most everything. Right. 0:46:33.360 --> 0:46:35.799 Plus, you can do it a lot easier. You don't 0:46:35.800 --> 0:46:39.040 need specialized equipment, you don't need specialists, you can just 0:46:39.600 --> 0:46:40.360 you just breathe. 0:46:40.719 --> 0:46:43.840 Yeah, it's really cool concept. I kind of love it. 0:46:43.880 --> 0:46:47.720 In the two decades or so after their early nineteen 0:46:47.719 --> 0:46:50.560 eighties letters in the Lancet. The world had definitely been 0:46:50.640 --> 0:46:54.040 changed by their discovery. Long term sufferers of gastritis and 0:46:54.080 --> 0:46:56.840 ulcers could find relief, and the risk of developing stomach 0:46:56.840 --> 0:47:00.920 cancer could even be reduced a bit. For their efforts, 0:47:01.400 --> 0:47:04.720 Barry Marshall and Robin Warren were awarded the Nobel Prize 0:47:04.719 --> 0:47:09.040 in Physiology or Medicine in two thousand and five, exactly 0:47:09.080 --> 0:47:13.360 one hundred years after Robert Koch was given the Nobel 0:47:13.440 --> 0:47:15.920 for his discovery of the tuberculosis bacterium. 0:47:16.560 --> 0:47:17.160 Wow. 0:47:17.719 --> 0:47:21.359 And I read that Robin Warren's wife, Wynn predicted them 0:47:21.400 --> 0:47:24.840 getting the prize all the way back in like nineteen 0:47:24.880 --> 0:47:28.680 eighty four after their first lance at pub was accepted. 0:47:29.120 --> 0:47:29.480 Really. 0:47:29.840 --> 0:47:31.840 Yeah, they went out to dinner and she was like, 0:47:31.920 --> 0:47:33.759 this is going to get you the Nobel Prize. 0:47:34.000 --> 0:47:37.000 That's adorable on so many levels. 0:47:37.080 --> 0:47:41.239 Yeah, isn't that? I really love it? Okay, all right, 0:47:41.400 --> 0:47:44.520 So with that, I'll hand it off to you. Aaron, 0:47:44.719 --> 0:47:48.080 tell me about the eppie of Helicobacter pylauri today. 0:47:48.520 --> 0:48:15.120 Oh, I can't wait too. Today, it's estimated that right 0:48:15.160 --> 0:48:20.879 around half of the world's population is infected with age pylori. 0:48:21.160 --> 0:48:22.400 That's a lot of people. 0:48:22.520 --> 0:48:23.520 It's a lot of people. 0:48:25.080 --> 0:48:28.320 So I found a recent paper that I will definitely 0:48:28.360 --> 0:48:30.320 post a link to because it has some nice maps. 0:48:30.400 --> 0:48:33.320 It's a meta analysis trying to really look at prevalence 0:48:33.480 --> 0:48:39.040 across different countries, and in developing countries the rate seems 0:48:39.080 --> 0:48:42.360 to be about fifty percent, in developed countries about thirty 0:48:42.400 --> 0:48:46.040 four percent, and overall global prevalence at least according to 0:48:46.080 --> 0:48:49.279 this study, was about forty five percent. So maybe it's 0:48:49.320 --> 0:48:51.359 going down a little bit from the numbers that we 0:48:51.480 --> 0:48:57.720 see cited most often. Okay, but obviously not every person 0:48:57.840 --> 0:49:01.040 infected with H. Pylori is going to get gastric cancer 0:49:01.239 --> 0:49:05.680 or even peptic ulcer disease. And there's a lot of 0:49:05.719 --> 0:49:09.120 research that's being done into the mechanisms of how H. 0:49:09.160 --> 0:49:12.840 Pylori causes disease. And one of the big thoughts is 0:49:12.840 --> 0:49:15.000 that it's virulence of the strain of H. 0:49:15.040 --> 0:49:15.520 Pylori. 0:49:16.480 --> 0:49:18.399 So there's a lot Like you said, there's a lot 0:49:18.400 --> 0:49:20.160 of diversity across H. 0:49:20.239 --> 0:49:20.680 Pylori. 0:49:21.120 --> 0:49:23.239 There's a lot of different strains, and some of them 0:49:23.280 --> 0:49:26.920 are more virulent than others, some produce more inflammation, and 0:49:27.000 --> 0:49:29.600 it tends to be that those that produce more inflammation 0:49:29.840 --> 0:49:33.800 are associated with higher risks of cancer, and it also 0:49:33.840 --> 0:49:37.080 could just be individual genetics. So if you are a 0:49:37.120 --> 0:49:40.400 person who's genetically predisposed to cancer and you happen to 0:49:40.400 --> 0:49:43.240 get an H. Pylori infection, then your risk of cancer 0:49:43.360 --> 0:49:45.000 might be additionally increased. 0:49:45.239 --> 0:49:47.560 Okay, but that's those. 0:49:47.400 --> 0:49:50.799 Are small studies in their infancy. We don't really know 0:49:52.040 --> 0:49:54.440 who is going to get cancer if they have an H. 0:49:54.480 --> 0:50:00.600 Pylori infection and who isn't at this point, right, So yeah, 0:50:00.800 --> 0:50:04.160 I found some a really interesting in one little paper 0:50:04.360 --> 0:50:08.919 that I'll link to where they talked about hookworms. Oh, 0:50:09.000 --> 0:50:12.040 they talked about helmets, and people are saying maybe infection 0:50:12.120 --> 0:50:14.880 with helmets, which we know can modulate the immune system, 0:50:15.120 --> 0:50:18.360 can reduce gastric inflammation and reduce the risk of cancer. 0:50:18.440 --> 0:50:21.960 So if you're coinfected with H. Pylori and helmets, maybe 0:50:22.000 --> 0:50:25.000 your risk is less of getting gastric cancer. 0:50:25.840 --> 0:50:28.960 Hold on, but that's first of all, that's bizarre. The 0:50:29.080 --> 0:50:34.880 second of all, doesn't didn't we learn that having chronic 0:50:34.920 --> 0:50:39.920 infection with helmets creates an inflammatory state which is often 0:50:40.040 --> 0:50:43.719 leads to an increased risk of cancer generally speaking, totally does? 0:50:43.840 --> 0:50:46.640 Yeah, so I don't understand it's not. 0:50:47.400 --> 0:50:50.120 There is not evidence that this is true in humans. 0:50:50.280 --> 0:50:53.319 It does seem to work in animal models. Okay, who 0:50:53.360 --> 0:50:56.840 knows it decreases your risk of gastric cancer but increases 0:50:56.840 --> 0:50:58.400 your risk of colorectal cancer. 0:50:58.640 --> 0:50:59.120 I don't know. 0:51:02.040 --> 0:51:04.239 I mean, you lose if you do, you lose if 0:51:04.280 --> 0:51:04.960 you don't. 0:51:04.920 --> 0:51:09.319 Right, we'd never win. Yeah, the bacteria always win. 0:51:10.760 --> 0:51:15.640 That is that's going to be on the gravestone of humanity. 0:51:15.760 --> 0:51:19.839 Yeah, So, in terms of gastric cancer, I thought people 0:51:19.920 --> 0:51:23.879 might be interested in some gastric cancer stats since that's 0:51:23.960 --> 0:51:25.719 kind of the most serious outcome of H. 0:51:25.800 --> 0:51:26.600 Pylori infection. 0:51:26.960 --> 0:51:31.000 I'm definitely Yeah, depending on what source you read, gastric 0:51:31.080 --> 0:51:35.040 cancer is either the second or third leading cause of 0:51:35.120 --> 0:51:36.040 cancer death. 0:51:37.000 --> 0:51:40.160 Really yes, wow. 0:51:39.880 --> 0:51:40.120 I know. 0:51:40.239 --> 0:51:43.040 I didn't realize that it was so high either. So 0:51:43.120 --> 0:51:47.439 the first is lung dizzy lung cancer. Okay, that's the 0:51:47.560 --> 0:51:51.560 number one cancer diagnosis and the leading cause of cancer death. 0:51:52.360 --> 0:51:55.040 And then the most recent stats that I saw actually 0:51:55.120 --> 0:51:58.680 had colorectal cancer causing more deaths than gastric cancer at 0:51:58.760 --> 0:51:59.759 least in this last year. 0:52:00.280 --> 0:52:03.160 Okay, and this is this is globally. 0:52:03.120 --> 0:52:05.399 This is globally, yeah, worldwide. 0:52:05.040 --> 0:52:07.120 And what numbers are we talking about? 0:52:07.680 --> 0:52:08.440 Great question. 0:52:10.560 --> 0:52:15.600 According to WHO, there were one point zero three million 0:52:16.280 --> 0:52:21.479 new cases of gastric cancer diagnosed in twenty eighteen, one 0:52:21.880 --> 0:52:22.920 million new. 0:52:22.840 --> 0:52:26.360 Cases, million new cases and in one year. 0:52:26.520 --> 0:52:32.480 In one year, and that's estimated, right, and seven hundred 0:52:32.520 --> 0:52:34.759 and eighty three thousand deaths. 0:52:35.160 --> 0:52:39.520 Oh my goodness, I know it's really high. 0:52:40.000 --> 0:52:44.320 For comparison lung cancer, which is number one, two point 0:52:44.400 --> 0:52:49.360 zero nine million cases, one point seven six million deaths. 0:52:49.880 --> 0:52:52.720 Okay, so similar. That's very interesting. Of the new cases 0:52:52.760 --> 0:52:55.120 and the death ratio is very similar with those. 0:52:56.080 --> 0:53:02.720 Yeah, we are, despite so much, not good at treating 0:53:02.719 --> 0:53:03.720 most cancers. 0:53:04.360 --> 0:53:06.239 Yeah, it seems like we have a long way to go. 0:53:06.600 --> 0:53:09.120 Yeah, the death rates for cancers like gastric cancer and 0:53:09.200 --> 0:53:13.879 lung cancer really have not decreased over recent decades. It's 0:53:14.040 --> 0:53:20.680 very very interesting. Actually it's alarming. Yeah, but the overall 0:53:20.760 --> 0:53:24.640 rates of diagnosis of gastric cancer do seem to be decreasing, 0:53:25.280 --> 0:53:27.520 and it's thought that this is due to a number 0:53:27.520 --> 0:53:28.200 of different things. 0:53:28.200 --> 0:53:28.960 But treatment of H. 0:53:29.000 --> 0:53:31.719 Pylori is really high on the list of things that 0:53:31.760 --> 0:53:34.760 we think have helped to decrease the incidence of gastric cancer. 0:53:35.800 --> 0:53:37.240 So that's really cool. 0:53:37.440 --> 0:53:41.839 Well, so thanks again to Marshall and Warren. Marsh mar 0:53:42.000 --> 0:53:45.240 By the way, can I put in a quick plug 0:53:45.320 --> 0:53:49.520 for the Nobel Museum in Stockholm? Yes, tell us all 0:53:49.560 --> 0:53:49.880 about it. 0:53:49.920 --> 0:53:50.720 You just visited. 0:53:50.880 --> 0:53:53.120 I was just there and it was First of all, 0:53:53.120 --> 0:53:56.120 Stockholm is amazing and the museums are incredible and everything 0:53:56.120 --> 0:53:57.400 about it is a wonderful place. 0:53:57.440 --> 0:54:01.000 And I like number one Abba Museum, number two Nobel Museum, 0:54:01.040 --> 0:54:01.279 is that. 0:54:01.280 --> 0:54:09.719 Right, Yeah, probably in that order. And yeah, so they 0:54:09.719 --> 0:54:14.280 have some cool little exhibits on these two, on Marshall 0:54:14.280 --> 0:54:18.480 and Warren, and they have the tube from which Marshall 0:54:18.680 --> 0:54:23.600 drank the inoculate to infect himself. Oh my gosh. 0:54:23.680 --> 0:54:26.160 I get so excited by things like that, like. 0:54:26.520 --> 0:54:28.279 Oh it was throng. I just stood there and I 0:54:28.360 --> 0:54:30.480 was like, I don't care if I'm blocking people. I 0:54:30.520 --> 0:54:33.160 need to see this. So I took a picture. Yeah, 0:54:33.200 --> 0:54:35.760 I'll definitely post it on social media. 0:54:36.080 --> 0:54:37.359 Excellent. Oh I can't wait. 0:54:38.400 --> 0:54:38.640 Yeah. 0:54:38.960 --> 0:54:41.160 Oh I love those kind of museums. They're so fun. 0:54:41.840 --> 0:54:44.319 They are so fun. Okay, sorry I totally interrupted you. 0:54:44.400 --> 0:54:48.000 So tell me. So what's going on with research or 0:54:48.080 --> 0:54:52.560 more preventative things for gastric cancer and peptic ulcers in general. 0:54:53.000 --> 0:54:57.359 Yeah, So there's a vaccine that's awesome. It's awesome, it's 0:54:57.360 --> 0:55:01.760 super exciting. It's undergone at least phase three clinical trials, 0:55:01.800 --> 0:55:04.120 which is usually sort of the last phase before things 0:55:04.200 --> 0:55:09.440 get licensed in China. It's an oral vaccine, but I 0:55:09.480 --> 0:55:13.800 know that I found studies earlier studies on injectable vaccines 0:55:13.800 --> 0:55:16.480 as well, but I think in this case, an oral 0:55:16.560 --> 0:55:20.480 vaccine makes so much sense because it's, first of all, 0:55:20.520 --> 0:55:23.440 it's a GI bacteria, So giving something orally means that 0:55:23.480 --> 0:55:27.000 the vaccine is producing immunity in the cells that are 0:55:27.040 --> 0:55:29.880 actually going to be exposed to the bacteria, right, So 0:55:29.920 --> 0:55:32.680 it's a great idea. But oral vaccines are also a 0:55:32.719 --> 0:55:35.200 lot easier to administer. You don't have to have specialized 0:55:35.239 --> 0:55:37.920 medical personnel. So I love that it's an oral vaccine. 0:55:38.400 --> 0:55:41.720 And the efficacy that they found so far is about 0:55:41.760 --> 0:55:45.839 seventy percent effective in preventing infection with H. Pylori, which 0:55:45.840 --> 0:55:47.040 is super exciting. 0:55:47.239 --> 0:55:48.080 Yeah. 0:55:48.200 --> 0:55:51.239 So I'll post a link both to the there's the 0:55:51.600 --> 0:55:54.440 phase three trial paper and then there's also a really 0:55:55.000 --> 0:55:55.960 cheeky paper. 0:55:56.160 --> 0:55:59.560 I want to read you the title of it. So 0:56:01.760 --> 0:56:06.920 it's called at last vaccine induced protection against Helicobacter pylori 0:56:08.320 --> 0:56:09.319 at last. 0:56:10.120 --> 0:56:12.160 So I'll post both of those on our website as 0:56:12.200 --> 0:56:14.879 well so that you can read more about it. But yeah, 0:56:14.880 --> 0:56:17.080 there is a vaccine which is very exciting. I'm not 0:56:17.120 --> 0:56:18.840 sure how much longer it will take to get to 0:56:18.920 --> 0:56:22.600 market in China, where you have higher prevalence of H. 0:56:22.640 --> 0:56:24.399 Pylori than you do in the States, and how long 0:56:24.440 --> 0:56:26.200 it might take to get it in the States, but 0:56:26.400 --> 0:56:28.640 it's pretty huge and very exciting. 0:56:28.920 --> 0:56:32.239 Yeah, I want that vaccine just in case. Well, I 0:56:32.239 --> 0:56:34.279 feel like, do you feel every time you get a 0:56:34.320 --> 0:56:37.440 vaccine a bit more like a superhuman? Like a superhero. 0:56:37.760 --> 0:56:40.200 We've talked about this. Yeah, I could totally see that. 0:56:40.560 --> 0:56:41.239 Yeah. 0:56:41.440 --> 0:56:41.760 Yeah. 0:56:42.239 --> 0:56:45.600 I also think this is so exciting because we are 0:56:45.680 --> 0:56:50.480 learning more and more about the associations with infectious disease 0:56:50.680 --> 0:56:51.920 and cancer. 0:56:51.840 --> 0:56:55.160 Yes, and other chronic diseases. 0:56:55.000 --> 0:56:59.520 Yes, And being able to produce a vaccine that literally 0:56:59.760 --> 0:57:00.880 pro events cancer. 0:57:01.560 --> 0:57:03.799 Are you kidding me? That's amazing. 0:57:04.280 --> 0:57:08.759 It's incredible. And I think that the number of unexplored 0:57:08.840 --> 0:57:12.319 links keeps growing, and those that are being explored also 0:57:12.400 --> 0:57:14.279 keeps growing, and I think that's just going to be 0:57:14.360 --> 0:57:17.240 one of the big futures of medicine is finding these 0:57:17.240 --> 0:57:19.480 links between infectious disease and chronic disease. 0:57:19.920 --> 0:57:20.560 Absolutely. 0:57:20.600 --> 0:57:23.919 I agree we're biased because we love infectious disease. 0:57:23.680 --> 0:57:27.480 But yeah, but no, it's it's huge and also really 0:57:27.520 --> 0:57:29.760 important if we can lessen some of the burden of 0:57:29.920 --> 0:57:30.920 disease around the world. 0:57:30.920 --> 0:57:31.400 Absolutely. 0:57:31.640 --> 0:57:32.200 Yeah. 0:57:32.600 --> 0:57:35.360 Oh so, yeah, that's h pylori. 0:57:35.920 --> 0:57:38.080 Wow. I really liked this one too. 0:57:38.120 --> 0:57:40.320 It was really fun today, had a great. 0:57:40.040 --> 0:57:43.160 Time researching it and talking about it. It's fun and 0:57:43.240 --> 0:57:46.360 learning about it. Yeah. Okay, all right, so should we 0:57:46.400 --> 0:57:50.720 do sources? Let's do it? Okay. So I have a 0:57:50.720 --> 0:57:54.120 bunch of different articles that I read and we'll post. 0:57:54.440 --> 0:57:57.120 I'll post all of these, but two I want to 0:57:57.160 --> 0:57:59.920 shout out. So one was called a century of Helicobacter 0:58:00.080 --> 0:58:05.360 pylori and that was by kid and Maudlin. And also 0:58:05.560 --> 0:58:09.040 I leaned very heavily on this incredibly thorough and long 0:58:09.080 --> 0:58:11.880 interview of Barry Marshall, which is what our first stand 0:58:11.880 --> 0:58:15.000 account was extracted from. So we'll definitely post all of 0:58:15.040 --> 0:58:16.959 those and the other articles as well. 0:58:17.520 --> 0:58:18.080 Excellent. 0:58:18.280 --> 0:58:20.280 Yeah, you can find all those on our website This 0:58:20.360 --> 0:58:23.840 podcast will Kill You dot com under the episode's tab. 0:58:23.960 --> 0:58:26.440 You can find all of our sources from this episode 0:58:26.440 --> 0:58:29.760 and every episode, and. 0:58:30.480 --> 0:58:32.560 What about you, any sources? None? 0:58:32.720 --> 0:58:34.680 I mean I shouted out the one and I'll post 0:58:34.680 --> 0:58:38.080 links to all of them, so okay, yeah cool. 0:58:39.000 --> 0:58:42.080 Thank you to Bloodmobile for providing the music for this 0:58:42.280 --> 0:58:43.400 and all of our episodes. 0:58:43.800 --> 0:58:47.360 And thank you all of you listeners. We love telling 0:58:47.360 --> 0:58:50.520 you about disease and we love hearing from you about 0:58:50.560 --> 0:58:54.440 your diseases and the diseases you want us to cover. Eventually, 0:58:54.600 --> 0:58:57.720 we have the longest list ever and it just keeps growing. 0:58:58.240 --> 0:59:00.720 And thanks. We love you. 0:59:01.120 --> 0:59:06.080 Yeah, thank you. Okay, well with that, wash your hands 0:59:06.280 --> 0:59:07.720 You filthy animals.