Exclusive Interview With Helicobacter pyloriExclusive Interview With

I have trouble falling asleep. At first I have bad dreams, which wake me up. Then I manage to fall asleep again. Suddenly a new scene floods my dreams.

Two small, hunchback, tortured spiral bacteria float beneath the rough, stormy sea of the stomach. Both remember that their ancestors fought to survive here a long time ago; some of their cousins desperately fight against the acidic tide, and only a few relatives are able to catch the plicae and enter the mucosa.¹ Other members of the same species appear on the surface only temporarily, dying quickly in the acidic-proteolytic ocean.² This is, no doubt, the most lonely place in the world. Suddenly a black cobra winds into the stomach. Light shines from one end, enabling one to look up into a human eye through a window. This is an endoscope. From another tunnel a terrible claw reaches out: a forceps. It bites into tissue and steals a piece containing one of the twisted bacteria.

The other crouches terrified, escape reflexes vibrating nervously; then—conquering its fear—it starts to speak.

"Excuse me, sir. Why are you doing this to us?"

"Who are you?!" the man at the opposite end of the snake asks in astonishment.

"You can call me Helicobacter pylori."

The physician doesn't believe his eyes and ears and continues to gaze at the swollen gastric mucosa and the acrid, foamy splash. This must be a nightmare—or delirium.

"This can't be true!" blurts out the man. "I can't believe I am talking to a bacterium."

"Sir, you couldn't unless I wanted you to. Do you think that Drs Marshall and Warren³ could have found me in 1983 if I hadn't wanted them to? I've lived here for millions of years. About 100 years ago I had a nice conversation with a bearded German gentleman—some Boettcher—and I managed to convince him that the stomach is fine as long as I am here.⁴ No one has bothered me since, not until 20 years ago, when I happened to meet the Australian gentlemen I mentioned. They did not believe me."

"I'm sorry, but this is nonsense. It seems I am indeed talking to a bacterium. I am afraid I must be going insane."

"Really, sir, actually you are not quite normal. If you were, you would consider some facts: You see, we are present in the stomach of many individuals who are asymptomatic and otherwise healthy and can be found only in about half of the stomachs of those who are ill.⁵ Of our nine cousins, only one displayed any signs of aggressiveness.⁶ This environment not only provides a place for acidic digestion, it also protects the entire digestive system from uninvited intruders.^{7 - 9} Did you not think that I might have some contributory role that you haven't yet discovered?^{10 - 12} Humankind has lived and grown with me inside, unlike other acid-resistant microorganisms, like tuberculosis and leprosy. I exist in this acidic wasteland, which prevents the digestive tract from very many kinds of infection.^{13 - 14} Because I can live only in this highly concentrated acid. It is strange, I know, but my alcalic coat keeps me from dissolving."

"I cannot believe my ears. But okay. So you say that you are an organism that helps instead of harms?"

"Yes, something like that. I do no harm. I huddle in and on the mucosa, as much as I can. I, naturally, discharge my metabolites there, and this is why you can detect my presence. Besides, it is funny that your test refers to IgG, indicating that we may have met in the past, instead of IgM, indicating active infection. I—unlike you—can live on urea, almost nothing at all. My metabolites, however, are cleared away nicely by the sanitation system of your highly developed organism."

"But this metabolism goes with an aggressive enzyme: urease. And its final product is harmful for the gastric tissue."

"Not at all, sir. The final product, in general, consists of hydrogen, carbon dioxide, and nitrogen. But you know this better than I do. What would happen if urea stayed intact in the stomach? Wouldn't it be really harmful?"

"Hmmmm. Who knows? However, we know that getting rid of you results in the healing of gastric and duodenal ulcers."

"Oho, but how? You kill us with expensive antibiotics. Do you think this is the solution? You kill part of the parietal cells with poisons. Devastation all around. If there is no acid, no peptic ulcer, as with "Helicobacter-negative" cases. Although we drown in our alcalic cap and will be killed by the antibiotics, we often come back in a month. In a case of achlorhydria, however, any pathogenic bacterial, fungal, or viral colonization can happen.^{14 - 15} This is bad for us too—we don't cause this to happen."

"Fortunately, you come back quickly to the stomach."

"Of course, as I said. Not us, but others from my extended family.¹⁶ But then the process of eradication starts all over again. This might be worthwhile for some, but what is the real point of it all? Where does the futility end?"

"What you're saying sounds odd, but it does make some sense. However, the people who make the rules have ordered you killed."

"But you see, I come in peace. I say, look at both sides. Maybe I am more useful than you think.^{10 - 12} My presence indicates and maintains the beneficial acidity of a practically healthy stomach with a moderate catarrh, destroys urea (and probably other needless compounds), and gives you hydrogen, nitrogen, and carbon ions. I really do not know what else I can do for you!"

"Hmmmmm. You've almost convinced me that you are a real benefit to humankind! Don't do this to me—everything I've learned so far has taught me the opposite. You are making me a little nervous. What should I do next?"

"Just accept that I am here, and I am here to stay. Things that are different are not necessarily bad. Imagine what would happen without me. But, first of all, do not be frightened of me. I do not prey on man or stomach."

Then I wake up. It is still dark and I see a woeful creature there in the dawning light that was not frightening or hostile. Perhaps we are the hostile ones because we do not understand. What is the truth?

Acknowledgment: I am grateful to Gregory and Zsofia Lippman for valuable advice and grammatical help.