The cure for the chronic ulcer is something I couldn’t wait for
Aug. 6, 2014
It was 50 years ago today that I started my second life, courtesy of Dr. William J .Egan and his team’s surgical skills in an operating room at the Carney Hospital on Dorchester Avenue. I had been diagnosed with a duodenal ulcer – an open sore in the lining of the small intestine – in 1955, when I was 12 years old and in the seventh grade. In the intervening years, the gnawing pain associated with outbreaks, usually in the spring and in the fall, made for an uneven social and academic life. Feeling okay one day, and punky the next, I made few firm plans and met the world on an ad hoc basis.
By the time I was a senior in college, there were no more okay days; the pain, now more burn than gnaw, was constant. By the first week of August 1964 I could not stand upright, and on the seventh day I collapsed in my bedroom at home. Systemic shock was setting in, a doctor told me later.
I have no recollection of the next several days save two: Dr. Egan telling me that “we can take care of this problem, Tommy,” and Father John Whitney Sullivan, SJ, standing at the end of my bed holding his missal and a small box. What the record shows is that my ulcer of nine years had perforated the lining of the duodenal wall, causing life-threatening chaos thereabouts, that my appendix had ruptured, and that I had been given the last rites by Father Sullivan. When Dr. Egan was talking to me he had already performed exploratory surgery and had scheduled another operation a few weeks out to remove a large section of my stomach, and with it, my ulcer issue.
There are few such operations today. Where estimates in the 1960s put the occurrence of ulcers in 10 of every 100 individuals, in 2014 you rarely hear of ulcers as a chronic disease. Where as recently as 30 years ago, ulcers were seen to be caused by physical, mental, and emotional stress, and exacerbated by eating spicy-type foods, today it is known that they are caused by excessive activity of a bacterium that is found in human stomachs – Helicobacter pylori, or, for short, h. pylori. But not that well known. In the last week, I have seen two outdated references to ulcer legend in widely circulated publications: “He doesn’t have ulcers, he gives them.”
For all that, it took until the 1980s when two stubborn Australian doctors, Barry Marshall and Robin Warren, wiped the slate clean of all ulcer-study precedent by claiming that ulcers were triggered by the H. pylori bacterium in the same way that other bacteria triggered colds. Marshall’s suggestion was met with guffaws of disbelief – until he concocted a batch of H. pylori, swallowed it whole and made for himself his very own growing patch for a peptic ulcer. From that evidence came the obvious inference that antibiotic therapy in some form was the answer to curing ulcers. And so it has happened.
In recent interviews, Dr. Marshall, who later moved to a professorship at the University of Virginia in Charlottesville and shared the 2005 Nobel Prize in Medicine with Warren for their wondrous discovery, has said that some 90 percent of ulcers diagnosed today are eliminated by antibiotic therapy, with a comeback rate of less than one percent. Noting that the long-term cost of treating an ulcer back in the day was about $10,000, he said that the modern-day one-time drug therapy costs about $100.
A personal footnote: For years after my surgeries in August 1964 I experienced no pain but, rather, dreary difficulties with bloating and mild stomach aches with gassy rumblings. In the mid-1980s I read a long article in the New Yorker magazine about what Dr. Marshall had done, which led me to wonder if some leftover H. pylori in my stomach was still giving me trouble. With some difficulty, I persuaded my internist to order a blood test, which showed that the bacterium was still active in my system. After two six-week regimens of bismuth and Tetracycline, the lingering symptoms of 20 years’ standing disappeared, and they haven’t come back.
Tom Mulvoy, a Dorchester native, is a retired managing editor of The Boston Globe who is working now as an associate editor with the Reporter.