With a gnarled trunk of fat knobs and twisted scowls, the sea grape tree squatted over the alley-way, the wrinkled branches laden with slender columns of ripening fruit. Leathery, glossy leaves the size of saucers, lined with fat, red veins, reflected the slivers of sunlight that slanted through the sloping canopy.
Always just beyond our reach in a tantalising corner of the neighbour’s yard, the tough plant would be laden each August, during our long annual school holidays. Unable to resist temptation, my three siblings and I would hurl small stones, swing skittishly with sticks or climb barefoot from above the sharp edges of the rusting galvanized fence that lined a dangerous side of our home, to snatch the best berries that stung the air with a strong, tangy scent, savouring rather soapy, salty seeds than satisfying, sweet flesh.
Maturing unevenly, the clusters would appear tightly packed with pale green balls, marked by the telltale pop of rich mauve and violet. We would rush to pick up the prized purples that smashed to the cracked ground of dry mud and dust, fighting the rush of sour flies, and pausing to toss those that the birds had stripped, cram our mouths and share.
Hands stained, we would retrieve the fruits that fell into the fetid gutter, give them a quick wash at the stand pipe and happily consume the lot. Except for the seasonal cold and flu, we thrived as a thin, then tall group, growing into adults, unbothered by food poisoning, widespread allergies and asthma, childhood dirt and ubiquitous germs.
So, it seemed unusual in 2004, when I was struck down by a sudden sickness, far from any fecund sea grape trees and festering drains, ironically while living in an impeccably clean house in the inland capital of Belmopan, having moved to Belize in Central America. Repeating to my alarmed family that I did not feel so well, I ran to the bathroom and vomited. I had no appetite. Nothing stayed down. Suffering from horrible headaches, incessant coughing, I felt tired all the time, lost weight and stopped sleeping well, as the antacids offered by my spouse against the constant acid reflux proved useless. A repeat victim of inherited hyperemesis gravidarum or grave morning sickness associated with pregnancy, I had already suffered through months of hospitalisation and intravenous feeding, to give birth to our two children, years earlier.
As my condition deteriorated, and immune system grew compromised, doctors raised the dreaded “c” disease, I had an endoscopy with a sample sent for analysis. It disproved peptic and duodenal ulcers, and stomach cancer but confirmed widespread inflammation and gastritis caused by a perplexing strain of spiral shaped bacterium called Helicobacter pylori (H.pylori). Fortu-nately, my cheerful gastroenterologist had kept up with the latest research, and he diagnosed gastroesophageal reflux disease (GERD), putting me on a strict regimen of a combination of antibiotics and supporting medication for weeks.
Humans are colonised by countless microorganisms important to health, including bacteria, fungi and viruses, with the traditional estimate of the body being inhabited by ten times as many non-human cells as human cells, but recent studies have cut that ratio to approximately the same number. According to the journal “Cell” a recalculation by the Weizmann Institute of Science in Israel reveals that the average healthy adult has just under 40 trillion bacterial cells and about 30 trillion human ones, making the ratio much closer to 1:1!
An ancient organism, Helicobacter pylori apparently originated from Africa, moving with the masses of first human migrants outwards into Asia and elsewhere. Today, typical strains representing geographic areas are identified as European, African and Asian. The bacterium is estimated to infect about half of the world’s population, nearly all in the developing world, including Caribbean countries such as Guyana with lower socio-economic standards. Intriguingly, only a small proportion of cases go on to get gastric cancer annually. Coevolving with us for nearly 60,000 years, the bacterium is generally acquired in infancy and often passed on in families such as mine. Different types predominate within certain regions of the world in correlation with human migration patterns. However most infected individuals do not indicate related disease, leading to the hypothesis that several H. pylori strains are harmless or even beneficial.
Some populations with an increased prevalence of H. pylori infection such as in China, Japan, and Korea have a greater incidence of associated diseases, due also to associated environmental factors. Yet, in other parts of the world, like India, Colombia, Costa Rica and Malaysia, and within Africa, researchers puzzle over the still-unsolved “Asian” or “African Enigma” – the defined high prevalence of infection but low incidence of gastric cancer among these populations.
Experts think environmental, genetic and bacterial factors may be the reason. One study cited the Indian province of Kashmir, where the reported rate of gastric cancer is 3–6 times above that in other districts. Increased consumption of salt and preserved foods by Kashmiris, compared with the use of fresh fruits and vegetables by southern Indians may explain the inverse relationship between the presence of H. pylori and gastric cancer, the paper suggested.
A landmark 2014 analysis in two Colombian villages showed that residents of European or Amerindian descent were at greater risk of getting more severe lesions, than were people of African background. The researchers concluded that coevolution among humans and H. pylori reduced gastric cancer disease risk in people of African descent. Those of Amerindian blood would have been exposed to European or African strains of H. pylori much more recently, meaning that there would not have been time for coevolution to take place.
The fact that I have survived with my stomach largely intact, was due to my alert doctor, and the dogged and dedicated detective work of the amazing Australian researchers, Drs. Barry J. Marshall and Robin Warren. In a stunning discovery in 1982, termed a “paradigm shift” the pioneering pair proved that infection with the curved, slow growing H. pylori unequivocally caused gastritis and stomach ulceration, and that it was cured with available antibiotics. By 1994, the International Agency for Research on Cancer classified H. pylori infection as the first bacterial Class I carcinogen for humans.
Struggling for years to gain acknowledgement from the skeptical medical community, Marshall and Warren came up against repeated negativism from an intimidating establishment that refused to listen or give up the long-standing belief that stress, and lifestyle factors were the major causes of peptic ulcer disease. Big drug companies made and still make billions across the world from aggressively marketing antacid and acid reducing drugs like Zantac, Tagamet and Nexium, unashamedly treating the symptoms and having no financial incentive to find a cure for a recurring disease.
Unable to find human volunteers, Marshall grew desperate, finally taking a bit of H. pylori from the gut of an ill patient. He swizzled the microbe into a cloudy broth and drank the brew the next morning. Five days later, ailing, he biopsied his own gut, cultured the bacterium and headed to the lab. He knew bismuth plus metronidazole cured the condition. “Helicobacter made us realize that we can’t confidently rule out infectious causes for most diseases that are still unexplained,” Marshall pointed out in an interview with Discover Magazine.
Still seeking a vaccine, Professor Marshall and a team of researchers at the University of Western Australia have since identified how the bacterium produces a waxy shield which protects it from stomach acid, allowing it to survive for long periods of time. Hopefully understanding the makeup will allow for new microbial treatments, but the efficacy of the drugs that were used to help me and untold others is fast decreasing. Helicobacter pylori is already resistant to clarithromycin and is number three on the “priority pathogens” high list of the World Health Organization (WHO) requiring urgent research and development of fresh antibiotics to continue saving lives.
ID celebrated quietly without special broth and superbugs when Barry Marshall and Robin Warren, “who with tenacity and a prepared mind challenged prevailing dogmas,” won the 2005 Nobel Prize for Medicine.