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Japanese doctor helped two Aussies win Nobel in medicine

Naomi Uemura, a 63-year-old physician who specializes in digestive organs, is credited with conducting the tenacious clinical research that helped two Australian doctors win the Nobel Prize in medicine in 2005.

Born in Kitakyushu, Uemura graduated from Hiroshima University and then honed his therapeutic skills at a number of hospitals, including one on a small island in the Seto Inland Sea.

After returning from a study program in the United States in 1989, he became chief physician at the department of digestive organs at Kure Kyosai Hospital in Kure, Hiroshima Prefecture.

It was at this time that Uemura received a test kit for the bacterium Helicobacter pylori from Hiroshima University Hospital.

In 1983, Australian pathologist Robin Warren, 77, and physician Barry Marshall, 63, discovered the hitherto unknown bacterial species living in a stomach, which was then considered free from bacteria.

Helicobacter pylori was linked with stomach and duodenum ulcers in Europe and the United States, but even the presence of the bacteria was called into question in Japan at that time.

The test kit, which took a long time to use, had been sent to Hiroshima University Hospital by a Japanese doctor studying in Germany. The hospital, however, could not handle it because it was exclusively treating critically ill patients.

The kit required a large number of samples to be taken from the gastric mucosa of patients at the initial stage of stomach ulceration.

Koji Sumii, 67, the director of Saiseikai Hiroshima Hospital who was then a lecturer at Hiroshima University Hospital, sent the kit to Uemura.

He turned to Uemura because the kit required patients to be closely monitored. Uemura, Sumii felt, had a “discerning eye,” did not prejudge patients’ conditions and was very detailed.

Uemura recalled thinking at first that the additional work was troublesome and wasteful since he did not believe that ulceration of the stomach was an infectious disease. But used the test kit to examine as many patients as possible with the help of a trainee doctor, Shiro Okamoto, and found that all those with either chronic gastritis or gastric ulcers tested positive for the new bacteria.

At that time, it was not yet known that the rate of infection from the bacteria was high among Japanese, reaching some 80 percent among the aged.

Continuing his clinical research, Uemura speculated that gastric mucosa infected with Helicobacter pylori caused atrophic gastritis, or a process of chronic inflammation of the mucosa that eventually leads to stomach cancer.

He then cleansed the stomachs of chronic gastritis sufferers with antibiotics.

Okamoto, 53, now head of the gastroenterological medicine department at Kure Kyosai Hospital, said he was surprised at the results.

“They (stomachs) cleaned off enough to make me doubt whether they were the same stomachs of the same persons.”

Uemura also cleansed the stomachs of patients who underwent endoscopic surgery to excise early-stage cancer so that any recurrence could be “readily found in a clean stomach.”

One of Uemura’s colleagues, Toshikazu Mukai, 58, did not cleanse stomachs with antibiotics but recognized consequential differences in October 1995 by conducting follow-up surveys on 173 patients.

The surveys found that while six patients whose stomachs were not cleansed suffered relapses of cancer, the disease did not return in any of those who had the bacteria eradicated.

Marshall was informed of the discovery and called Uemura, saying he would receive the Nobel Prize if the survey finding proved correct.

Uemura subsequently conducted tenacious follow-up surveys on some 1,500 patients and made a database from them. In 2001, he released a paper saying that the presence of Helicobacter pylori increases the risk of stomach cancer.

In 2005, Warren and Marshall won the Nobel Prize in physiology or medicine for their discovery of Helicobacter pylori and its role in gastritis and peptic ulcer disease, upsetting the widespread belief that stress and lifestyle were the major causes of the diseases.

Cleansing of the stomach has since come to be widely practiced to treat early-stage cancer and ulceration.

At the Center Hospital of the National Center for Global Health and Medicine in Tokyo, physician Naoyoshi Nagata, 39, leads young doctors in data analysis and discussions based on the lessons he learned from Uemura when the latter was head of the endoscopic treatment section at the hospital.

“I learned (from Uemura) that doctors should consider questions raised by patients,” Nagata said.

Nagata has released some 30 dissertations in English since 2012, spending nights and holidays on research and writing.

“When I’m busy, questions occur to me,” he said. “Busy doctors should conduct clinical research. Otherwise, they cannot find answers to current problems.”

Uemura himself stressed that clinical researchers should have “pure” questions in mind, such as how to improve patients’ conditions and whether a particular therapeutic approach is really correct.

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