For the discovery of the Helicobacter Pylori,  the causative agent in Gastritis and Gastric Ulceration

The winners of the inaugural Florey Medal, awarded in 1998, were Dr Robin Warren of the Department of Pathology, Royal Perth Hospital, Western Australia, and Professor Barry Marshall of the Department of Medicine, University of Western Australia.

The nominated achievement for which these scientists won the Medal was their identification of a new bacterium, Helicobacter pylori, and their discovery that this bacterium was the cause of both gastritis (inflammation of the stomach) and of gastric ulcer. These discoveries have had a profound effect on both the management of gastroduodenal disease, and the clinical practice of gastroenterology.

What Warren and Marshall did, in chronological order,was to:

1. notice that inflammation of the stomach (gastritis) was associated with the presence of a bacterium (Warren);
2. study 100 patients, and discover that this bacterium was present in every patient who suffered from a duodenal ulcer (Warren and Marshall);
3. grow the first culture of the bacterium, which was later named Helicobacter pylori (Marshall and microbiologists from Royal Perth Hospital);
4. swallow a culture of this bacterium, and suffer acute symptoms, in order to prove the hypothesis that H. pylori was the cause of gastritis and peptic ulceration (Marshall);
5. promote this hypothesis, despite significant scepticism from gastroentology specialists;
6. through persistence and publication of research papers, stimulate much research and treatment trials which eventually proved that H. pylori did indeed cause gastritis and gastric ulcers.

Following this confirmation of Warren and Marshall's hypothesis, it was demonstrated that antimicrobial therapy would eliminate H. pylori from the stomach, and thus, for the first time, gastric ulcers could be cured completely. This has had profound implications, since ulcer disease has been a major medical problem in most countries of the developed world: in Australia alone, one in ten people might expect to suffer from ulcer disease over their lifetime. Furthermore, prior to the discovery of H. pylori and the method for its eradication, many ulcers resulted in severe complications. Previous ulcer medications could provide temporary healing of the ulcer, but 80% of patients would suffer a relapse within a year of stopping treatment. The discovery of H. pylori resulted in a complete reassessment of ulcer treatment, and antimicrobial therapy is now accepted as an essential part of the management of ulcer disease.

Since Warren and Marshall's first articles on Helicobacter pylori appeared in the prestigious medical journal The Lancet in 1983, interest in, and articles about, H. pylori have proliferated, and the study of this bacterium has become a research industry in itself. This fact alone demonstrates the importance of Warren and Marshall's discovery in the clinical field of gastroenterology. According to Professor Adrian Lee of the School of Microbiology and Immunology, University of New South Wales, Sydney, "It could be argued that the Warren and Marshall finding is the most significant event in medicine in Australia in the last 20 &endash; 30 years".

The significance of Warren and Marshall's discovery has been reflected in the awards they have won for their work in uncovering H. pylori, namely:

• the Warren Alpert Prize (1995) (Warren and Marshall)
• the Albert Lasker Award (1995) (Marshall)
• the John Scott Award (1995) (Marshall)
• the Gairdner Award (1996) (Marshall)
• the Paul Ehrlich Prize (1997) (Warren and Marshall)
• the Kilby Prize (1997) (Marshall)

and of course, the Florey Medal (1998) (Warren and Marshall).

Below is a list of some relevant publications by Warren and Marshall, relating to their discovery of Helicobacter pylori:

• Forbes GM, Glaser M, Cullen D, Warren JR, Marshall BJ, Collins BJ (1994) Seven year follow-up of duodenal ulcer treated with H. pylori eradication therapy, Lancet 343 (8892): 258-260.
  
• Marshall BJ (1983) Unidentified curved bacillus on gastric epithelium in active chronic gastritis, Lancet 1: 1273-1275
  
• Marshall BJ, Warren JR (1984) Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration, Lancet 1: 1311-1315
  
• Marshall BJ, Royce H, Annear DI, Goodwin CS, Pearman J, Warren JR, Armstrong J (1984) Original isolation of Campylobacter pyloridis from human gastric mucosa, Microbios Letters 25: 83-88
  
• Marshall BJ, Armstrong JA, McGechie DB, Glancy RJ (1985) Attempt to fulfill Koch's postulates for pyloric Campylobacter, Med J Aust 142: 436-439
  
• Marshall BJ, Warren JR, Francis GJ, Langton SR, Goodwin CS, Blincow E (1987) Rapid urease test in the management of Campylobacter pyloridis-associated gastritis, Am J Gastroent 82: 200-210
  
• Marshall BJ, Goodwin CS, Warren JR, Murray R, Blincow ED, Blackbourn SJ, Phillips M, Waters TE, Sanderson CR (1988) A prospective double-blind trial of duodenal ulcer relapse after eradication of Campylobacter pylori, Lancet 2: 1437-1442
  
• Marshall BJ, Surveyor I (1988) Carbon-14 urea breath test for the diagnosis of Campylobacter pylori associated gastritis, J Nucl Med 29: 11-16
  
• Warren JR (1983) Unidentified curved bacilli on gastric epithelium in active chronic gastritis, Lancet 1: 1273
  
• Warren JR (1984) Spiral bacteria of the gastric antrum, Med J Aust 141: 477-478

Further information about Helicobacter pylori can be found at the Helicobacter Pylori Laboratory website.