The surprising cause of stomach ulcers - Rusha Modi

譯者: Lilian Chiu 審譯者: Helen Chang

In 1984, an enterprising Australian doctor named Barry Marshall

1984 年，一位很有 進取心的醫生貝瑞馬歇爾

decided to take a risk.

決定要冒個險。

Too many of his patients were complaining of severe abdominal pain

他有太多病人抱怨

胃潰瘍引起的嚴重腹痛，

due to stomach ulcers,

which are sores in the lining of the upper intestinal tract.

胃潰瘍就是上消化道中的潰瘍。

At the time, few effective treatments for ulcers existed,

當時，能有效治療 胃潰瘍的方式很少，

and many sufferers required hospitalization or even surgery.

許多病患需要住院或甚至動手術。

Desperate for answers,

因為極度渴望找到答案，

Dr. Marshall swallowed a cloudy broth of bacteria

馬歇爾醫師喝下了 一碗混濁的細菌培養液，

collected from the stomach of one of his patients.

細菌是從他其中一位 病人的胃裡收集來的。

Soon, Dr. Marshall was experiencing the same abdominal pain,

沒多久，馬歇爾醫師 就開始感受到同樣的腹痛、

bloating,

脹氣，

and vomiting.

和嘔吐。

Ten days later, a camera called an endoscope

十天後，一種叫內視鏡的相機

peered inside his insides.

進入他的體內窺探。

Marshall's stomach was teeming with the same bacteria as his patient.

馬歇爾的胃裡滿是 和這位病人相同的細菌。

He'd also developed gastritis, or severe inflammation of the stomach,

他還得了胃炎， 也就是胃部的嚴重發炎，

the hallmark precursor of ulcers.

這是胃潰瘍的特殊前兆。

Dr. Marshall's idea challenged

馬歇爾醫師的想法挑戰了

a misconception that still persists to this day:

一個至今仍然存在的誤解：

that ulcers are caused by stress,

胃潰瘍的成因是壓力、

food,

食物，

or too much stomach acid.

或是胃酸過多。

Marshall thought the culprit was bacterial infections.

馬歇爾認為罪魁禍首是細菌感染。

一開始，他的想法被全球

Initially, his idea was considered crazy

by the brightest medical minds on the planet.

最聰明的醫學專家視為瘋言瘋語。

But in 2005, he and Dr. Robin Warren received the ultimate validation

但是在 2005 年， 他和羅賓華沃倫醫師

得到了諾貝爾醫學獎的終極認可。

when they were awarded the Nobel Prize for medicine.

Our stomachs are J-shaped organs with surprisingly intricate ecosystems

我們的胃是個「J」型的器官， 有著非常複雜精細的生態系統，

awash in hormones and chemicals.

充滿了賀爾蒙和化學物質。

The stomach is under constant attack by digestive enzymes,

胃經常會受到攻擊， 攻擊來自消化酵素、

bile,

膽汁、

proteins,

蛋白質、

microbes,

微生物，

and the stomach's own acid.

和胃自己的胃酸。

In response, it produces bicarbonate,

胃對攻擊的回應是產生碳酸氫鹽、

mucus,

黏液，

and phospholipids called prostaglandins

和磷脂質，叫做「前列腺素」，

to maintain the integrity of its own lining.

目的是要來維持其內襯的完整性。

This delicate balance is constantly regulated

這精細的平衡經常會被調整，

and referred to as mucosal defense.

且被稱為「黏膜防禦」。

Since the mid-1800s, doctors thought stress alone caused most stomach ulcers.

從十九世紀中開始，醫師就認為 大部分胃潰瘍是單單由壓力造成。

Patients were given antidepressants or tranquilizers

他們會給予病人 抗憂鬱藥物或鎮靜劑，

and told to visit health spas.

告訴病人要去做健康水療。

這種想法最後衍伸出類似的概念，

This belief eventually shifted to the related notion of spicy foods

認為辛辣食物和壓力都是罪魁禍首。

and stress as culprits.

Yet no convincing study has ever demonstrated that emotional upset,

然而，始終都沒有一篇 具說服力的研究來指出情緒低潮、

psychological distress,

心理壓力，

or spicy food

或辛辣食物

directly causes ulcer disease.

會直接引起胃潰瘍疾病。

By the mid-20th century, it was widely accepted that excess hydrochloric acid

到了二十世紀中，被廣為 接受的說法是：過量的鹽酸

prompted the stomach to eat itself.

會促使胃腐蝕自己。

Fervent proponents of this idea were referred to as the acid mafia.

這個想法的熱衷支持者 被稱作「酸之黑手黨」。

The biggest hole in this theory was that antiacids only provide

這個理論最大的漏洞就是， 制酸劑只能帶來

temporary relief.

短暫的緩解。

We now know that some rare ulcers

我們現在知道有些罕見的潰瘍

are indeed caused by too much hydrochloric acid.

確實是由過量鹽酸所造成的。

But they make up less than 1% of all cases.

但它們只佔了 全部病例的不到 1%。

馬歇爾醫師和華倫醫師 鎖定了一種螺旋狀的細菌，

Dr. Marshall and Dr. Warren pinpointed a spiral-shaped bacteria

called Helicobacter pylori, or H. pylori, as the real offender.

叫做「幽門螺旋桿菌」， 簡稱 H. pylori，才是真兇。

H. pylori is one of humanity's oldest and most frequent companions,

幽門螺旋桿菌是人類最古老 且最常見的同伴之一，

having joined us at least 50,000 years ago,

在至少五萬年前就已經加入我們，

and now found in 50% of people.

現在 50% 的人身上都帶著它。

Previously, we thought the stomach was sterile

過去，我們以為胃是無菌的，

on account of it being such an acidic, hostile environment.

因為它是酸性、不友善的環境。

Yet H. pylori survives the acidic turmoil of the stomach

但，幽門螺旋桿菌能在 胃的酸性混亂中生存，

with a variety of features that disrupt mucosal defense in its favor.

具有多種特性，能為自身利益 去干擾黏膜防禦。

For example, it produces an enzyme called urease

舉例來說，它會產生 一種叫「尿素酶」的酵素，

that helps protect it from the surrounding gastric acid.

能協助保護它不受周圍胃酸的影響。

幽門螺旋桿菌能製造 超過 1500 種蛋白質，

H. pylori can make over 1,500 proteins,

many of which are dedicated to maximizing its virulence.

其中許多是專門用來 將其致命度給最大化。

We still have unanswered questions,

我們仍有未解開的問題，

like why specific people develop ulcers at particular times.

例如，為什麼某些人 在特定時間會出現潰瘍。

However, we do know individual genetics,

然而，我們確實知道，個人遺傳、

other medical problems,

其他健康問題、

use of certain medications,

某些藥物的使用、

smoking,

吸菸，

and the genetic diversity of Helicobacter strains all play a role.

及幽門螺旋桿菌菌株的 基因多樣性，都是相關的因素。

尤其是某些用來減輕 關節炎的止痛藥物，

In particular, certain pain medications used to reduce inflammation in joints

have been discovered to work with H. pylori

已經被發現會與幽門螺旋桿菌作用，

to create more severe stomach ulcers.

產生更嚴重的胃潰瘍。

Dr. Marshall ended up being fine after his famous, albeit dangerous, experiment.

馬歇爾醫師最後安然度過了 他那著名但危險的實驗。

He ingested a course of antibiotics similar to the ones taken now for ulcers.

他服用了一個療程的抗生素， 類似現今治療潰瘍用的抗生素。

To be treated by simple antibiotics is a modern triumph

以前需要動手術處理的疾病，

現在能用簡單的抗生素 來治療，是現代的勝利。

for a disease that previously needed surgery.

Marshall's work also reminded us that scientific progress is not always smooth.

馬歇爾的研究也提醒我們， 科學進步不見得永遠是順利的。

But there's value in trusting your proverbial,

但有時相信直覺是值得的。 （英文字面意思：肚子裡的感覺）

and sometimes literal, gut.