History of Helicobacter pylori, duodenal ulcer, gastric ulcer and gastric cancer

Abstract

Helicobacter pylori (H. pylori) infection underlies gastric ulcer disease, gastric cancer and duodenal ulcer disease. The disease expression reflects the pattern and extent of gastritis/gastric atrophy (i.e., duodenal ulcer with non-atrophic and gastric ulcer and gastric cancer with atrophic gastritis). Gastric and duodenal ulcers and gastric cancer have been known for thousands of years. Ulcers are generally non-fatal and until the 20^th century were difficult to diagnose. However, the presence and pattern of gastritis in past civilizations can be deduced based on the diseases present. It has been suggested that gastric ulcer and duodenal ulcer both arose or became more frequent in Europe in the 19^th century. Here, we show that gastric cancer and gastric ulcer were present throughout the 17^th to 19^th centuries consistent with atrophic gastritis being the predominant pattern, as it proved to be when it could be examined directly in the late 19^th century. The environment before the 20^th century favored acquisition of H. pylori infection and atrophic gastritis (e.g., poor sanitation and standards of living, seasonal diets poor in fresh fruits and vegetables, especially in winter, vitamin deficiencies, and frequent febrile infections in childhood). The latter part of the 19^th century saw improvements in standards of living, sanitation, and diets with a corresponding decrease in rate of development of atrophic gastritis allowing duodenal ulcers to become more prominent. In the early 20^th century physician’s believed they could diagnose ulcers clinically and that the diagnosis required hospitalization for “surgical disease” or for “Sippy” diets. We show that while H. pylori remained common and virulent in Europe and the United States, environmental changes resulted in changes of the pattern of gastritis producing a change in the manifestations of H. pylori infections and subsequently to a rapid decline in transmission and a rapid decline in all H. pylori-related diseases.

Keywords: Helicobacter pylori; Duodenal ulcer; Gastric ulcer; Gastric cancer; Medical history; Ulcer surgery; Epidemiology; Gastritis; Atrophic gastritis; Antiquity

Core tip:Helicobacter pylori (H. pylori)-related diseases reflect the pattern and extent of gastritis/atrophy (i.e., duodenal ulcer signifies the presence of non-atrophic gastritis whereas gastric ulcer and gastric cancer signify atrophic gastritis). While, it has been suggested that gastric ulcer and duodenal ulcer both arose or became more frequent in Europe in the 19^th century, the available data are more consistent with a change in the pattern of gastritis related to environmental conditions which previously had resulted primarily in atrophic gastritis. Duodenal ulcer then dominated clinically until the rapid decline in H. pylori transmission resulted in a rapid decline in all H. pylori-related diseases.