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The medical community was slow to recognize the role of this bacterium in stomach ulcers and gastritis, believing that no microorganism could survive for long in the acidic environment of the stomach. The community began to come around after further studies were done, including one in which Marshall drank a Petri dish of H. pylori, developed gastritis, and the bacteria were recovered from his stomach lining, thereby satisfying three out of the four Koch’s postulates. The fourth was satisfied after a second endoscopy ten days after inoculation revealed signs of gastritis and the presence of “H. pylori”. Marshall was then able to treat himself using a fourteen day dual therapy with bismuth salts and metronidazole. Marshall and Warren went on to show that antibiotics are effective in the treatment of many cases of gastritis. In 1994, the National Institutes of Health (USA) published an opinion stating that most recurrent gastric ulcers were caused by H. pylori, and recommended that antibiotics be included in the treatment regimen.^[7] Evidence has been accumulating to suggest that duodenal ulcers are also associated with H. pylori infection.^[8][9] In 2005, Warren and Marshall were awarded the Nobel Prize in Medicine for their work on H. pylori.^[10]

Before the appreciation of the bacterium’s role, stomach ulcers were typically treated with medicines that neutralize gastric acid or decrease its production. While this worked well, the ulcers very often reappeared. A very often used medication against gastritis and peptic ulcers was bismuth subsalicylate. It was often effective, but fell out of use, since its mechanism of action was a mystery. Nowadays it is quite clear that it is due to the bismuth salt acting as an antibiotic. Today, many stomach ulcers are treated with antibiotics effective against H. pylori.