Robin Warren, pathologist who identified the true cause of most stomach ulcers – obituary
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Robin Warren, who has died aged 87, was an Australian pathologist who shared the 2005 Nobel Prize in Physiology or Medicine with his colleague Barry Marshall for their discovery of a bacterium, Helicobacter pylori, and identifying it as a major cause of stomach inflammations and ulcers.
Their breakthrough came about not as a result of complex scientific research, but from old-fashioned medical detective work. As a result of their efforts, however, ulcers are now commonly treated with antibiotics, plus drugs to control the production of acid in the stomach or heal any damage done by the ulcer.
For decades – centuries even – doctors believed that stomach ulcers were caused by stress, spicy foods or too much acid, so treated them with antacids and dietary changes. In 1981, however, Warren, a pathologist at the Royal Perth Hospital who was studying stomach biopsies, noticed inflammation in areas with colonies of small, curved bacteria in about 50 per cent of patients from whom biopsies had been taken.
Marshall, then working as a medical registrar at the hospital, became interested in Warren’s findings and together they initiated a study of biopsies from 100 patients. After several attempts, Marshall succeeded in cultivating the bacterium, which they called Helicobacter pylori. They found that the organism was present in almost all the patients with gastric inflammations and duodenal and gastric ulcers.
When they announced their findings in 1982, the medical profession, in time-honoured fashion, was dismissive. “For about 100 years, or 1,000 years, the standard teaching in medicine was that ... the stomach was sterile and nothing grew there because of corrosive gastric juices,” Warren recalled. “So everybody believed there were no bacteria in the stomach. When I said they were there, no-one believed it.”
To prove the point, in 1985 Marshall drank a Petri dish of bacterial broth to show that the presence of H pylori in people with ulcers was no coincidence. A week later, after suffering stomach pain, nausea and vomiting, he underwent an endoscopy, which showed the distinctive spiral-shaped bacteria crowding around the inflammation in his stomach. His wife urged him to get treatment – which he did, and after a short course of antibiotics he was cured.
Even so, it took around a decade for others to fully accept their findings.
Ulcers had been a significant medical problem for decades, filling hospital beds. Both duodenal and gastric ulcers can perforate, causing an acute surgical emergency. Chronic gastric ulcers can also sometimes undergo malignant change, leading to stomach cancer.
The Nobel committee noted that Warren and Marshall had made an “irrefutable case” that H pylori is responsible for more than 90 per cent of duodenal ulcers and up to 80 per cent of gastric ulcers. Their pioneering discovery, the committee went on to observe, meant stomach ulcers were no longer a chronic, disabling condition, but a disease that could be cured.
John Robin Warren was born on June 11 1937 and took a degree in medicine at the University of Adelaide. After training at the Royal Adelaide Hospital he became a registrar in clinical pathology at the Adelaide Institute of Medical and Veterinary Science.
In 1963 he was appointed Honorary Clinical Assistant in Pathology and Honorary Registrar in Haematology at the Royal Adelaide Hospital. Subsequently, he lectured in pathology at Adelaide University, then took up the position of Clinical Pathology Registrar at the Royal Melbourne Hospital.
In 1967 he became a senior pathologist at the Royal Perth Hospital where, as well as his work with Marshall, he developed a diagnostic breath test for detecting H pylori in ulcer patients.
Warren retired in 1997 after the death of his wife Winifred, a psychiatrist, with whom he had five children.
He was appointed a Companion of the Order of Australia in 2007.
Robin Warren, born June 11 1937, died July 23 2024
