摘要：

Bacteria, gastritis, acid hyposecretion and peptic ulcer Spiral organl.·sms have been noticed in the stomachs of humans and animals since the turn of the century,' but the advent of modernbacteriological techniques, peroral gastric biopsy and electron microscopy has made further progress possible. The significant study of recent times on this topic was that of Marshall and Warren, who reported finding curved bacilli in the stomachs of patients with peptic ulcers and gastritis.' This has stimulated world-wide interest, unequalled by any other observation in relation to gastric disease. The editorial comment in"JheLancetdescribed the paper as "an unusual paper from Western Australia concerning the unanswered questions surrounding peptic ulcer and gastritis and a possible relation of curved gastric mucosal bacteria to their aetiology"." The development in recent months in the understanding of the relationship of these three factors is clarified in articles by Marshall et al. in the current issueof the Journal (pages 436 and 439). Initially, an attempt was made to fulfil Koch's postulates for pyloric campylobacter (page 436). A volunteer with normal gastric mucosa swallowed a culture of pyloric campylobacter; a mild illness followed, which developed after seven days, and persisted for 14 days. Histologically, the picture was that of gastritis with campylobacter-Iike organisms adherent to the epithelial cells. Marshall et al. postulate the existence of a syndrome of acute pyloric campylobacter gastritis, which is usually controlled by the host's defence mechanisms; however, in those individuals who are unable to clear the infection, chronic gastritis may develop. The acute gastritis is associated with hypochlorhydriaand, on review,the syndrome of epidemic gastritis with hypochlorhydria, described in the United States by Ramsey et al.,' appears to represent the syndrome of matched community controls free of gastric acute pyloriccampylobacter gastritis. disease and dyspepsia. Marshall et al. hypothesize, with some The gratitude of all those interested in justification, the sequence of events linking gastric disease should go to Marshall et al. campylobacter-like organisms, gastritis and for their contribution, and their further ulcer. Initially, an episode of acute gastritis observations are awaited with interest. Of which may be asymptomatic occurs. particular relevance is the prevalence of The latter may either resolve rapidly or percampylobacter-Iike organisms in individuals sist as 'chronic gastritis with achlorhydria who are free of dyspepsia; the prognosis which can last from three to 12 months. As of campylobacter-like organism-associated the patient develops immunity, the inflamulcerscompared to that of ulcers free of this mation will regress and the acid secretion bacterium; the short-term and long-term will return to normal. In this final stage, responses of campylobacter-like organismwhich is characterized by chronic gastritis associated ulcer to antibiotic therapy; and and the return of acid secretion, an imthe association of the bacteria with other balancebetween a mucosal resistancewhich ulcer risk factors, such as smoking and the is impaired by gastritis and acid secretion ingestion of analgesic agents. If the may lead to the development of a peptic", hypotheses of Marshall et al. withstand the ulcer. Pyloric campylobacter gastritis is, challenges forthcoming when these addithus, the common factor linking gastritis tional data are obtained, then their work will (both acute and chronic), achlorhydria and remain forever as a landmark in our peptic ulcerati~n. . knowledge of ulcer disease. The major question, as Marshallet al. emDOUGLAS W. PIPER phasize, is whether the bacterium is the Pro~esso~ of Medicine primary cause of the lesions observed or is The Umverstt~ of Sydney merely an, opportunistic commensal of at TheRoyal North Shore H~sPltal, SYdn~y Previously abnormal mucosa that is as I. Rollason :rp,Stone J,Rhodes JM. Spiralorganisms ~n . '. .' endoscopic biopsies of the human stomach. J Clin Bradford HIlI has

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