Dr. Barry Marshall was so determined to convince the world that bacteria — not stress — caused ulcers that he drank a batch of it.

Five days later he was throwing up, and he had severe stomach inflammation for about two weeks.

It was just the result he was hoping for. His bold action over 20 years ago symbolized the perseverance Marshall brought to proving a controversial idea — one that gained the ultimate validation Monday as he and Dr. Robin Warren won the Nobel Prize in medicine.

The discovery by the two Australians that ulcers weren’t caused by stress, but rather by the bacterium Helicobacter pylori, turned medical dogma on its head. As a result, peptic ulcer disease has been transformed from a chronic, frequently disabling condition to one that can be cured by a short regimen of antibiotics and other medicines, said the Nobel Assembly of the Karolinska Institute in Stockholm.

'No one believed it'
Warren, a retired pathologist, said it took a decade for others to accept their findings.

The long-standard teaching in medicine was that “the stomach was sterile and nothing grew there because of corrosive gastric juices,” he said. “So everybody believed there were no bacteria in the stomach.”

“When I said they were there, no one believed it,” he added.

The two researchers began working together in 1981. “After about three years we were pretty convinced that these bacteria were important in ulcers and it was a frustrating time for the next 10 years though because nobody believed us,” said Marshall, a researcher at the University of Western Australia.

“The idea of stress and things like that was just so entrenched nobody could really believe that it was bacteria. It had to come from some weird place like Perth, Western Australia, because I think nobody else would have even considered it.”

Marshall later wrote that he consumed the germ-laden drink himself in July 1984 because it was impossible to infect rats, mice and pigs with the bug. He was fine for about five days, then he began to get early-morning nausea and vomiting.

The stomach inflammation he was hoping for lasted about two weeks, he told The Associated Press on Monday.

“I didn’t actually develop an ulcer, but I did prove that a healthy person could be infected by these bacteria, and that was an advance because the skeptics were saying that people with ulcers somehow had a weakened immune system and that the bacteria were infecting them after the event.”

Curing ulcers with antibiotics
He and Warren believed the bacteria came first, causing inflammation, then ulcers. The experiment helped establish that.

Dr. David A. Peura, president of the American Gastroenterological Association, said the prize-winning work “revolutionized our understanding of ulcer disease” and “gave millions of people hope.”

He read about the H. pylori theory in 1983 while serving as a gastroenterologist in the Army, and “I thought it was crazy,” he recalled Monday.

But he and a colleague were intrigued, and soon they discovered they could cure ulcers in their own patients with antibiotics targeted at H. pylori.

“It was such an intriguing theory that everybody tried to disprove it and couldn’t, so we all became believers,” said Peura, now a professor of medicine at the University of Virginia at Charlottesville.

Peura, who met Marshall when both worked at the university and considers him a friend, said Marshall’s perseverance was responsible for the eventual acceptance of the theory. “Any lesser of a person probably would not have been able to withstand some of the ridicule and scorn that was thrown at him initially,” Peura said.

Marshall and Warren celebrated their new honor with champagne and beer.

“Obviously, it’s the best thing that can ever happen to somebody in medical research. It’s just incredible,” Marshall said by telephone from Perth, the Western Australia state capital, where the pair were celebrating with family members.

Warren said he was “very excited also a little overcome.”

Their work has stimulated research into microbes as possible reasons for other chronic inflammatory conditions, such as Crohn’s disease, ulcerative colitis, rheumatoid arthritis and atherosclerosis, the Nobel assembly said in its citation.

The discovery came about after Warren had observed bacteria colonizing the lower part of the stomach of patients and noted that signs of inflammation were always present close to the bacteria. Marshall became interested in Warren’s findings and together they launched a study of more patients.

Marshall also succeeded in cultivating the previously unknown bacterium from patient biopsies, in part because he accidentally left a sample in his lab over the Easter holiday in 1982 — unwittingly giving his cultures time enough for success.

Together, the two men found H. pylori present in almost all patients with stomach inflammation or ulcers in the stomach or the part of the small intestine called the duodenum.

The Nobel prize in physics will be awarded Tuesday and the chemistry prize on Wednesday. Those for literature, peace and economics will follow.