Come and see! An autobiography from a stomach cell…

Author: Lu Ting Shanghai Jiao Tong University School of Medicine

Dai Qihua Shanghai Jiao Tong University School of Medicine

Zhang Yeqian Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine

Painting: Zhang Wenxun Shanghai Jiao Tong University School of Medicine

Reviewer: Qin Jun, deputy chief physician of Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine

It is said that there are eight major forces in the "Ren" country, which monopolize major industries throughout the country. All the population of the country works in companies controlled by these eight forces, and I am one of these ordinary workers. My name is Cell.

Figure 1 Copyright photo is not authorized for reproduction

I work in the sphere of influence of "Digestion", which has five companies under it, and the bosses are Kou (mouth), Yan (throat), Shiguan (esophagus), Wei (stomach) and Chang (intestine).

Figure 2 Copyright image, no permission to reprint

1. Tragedy: Acute erosive gastritis

Time goes back to 2 a.m. in Weishi. The lights of a "gastric acid factory" are still as bright as day. Countless busy figures are reflected on the windows. This is me and my friends working overtime. Suddenly, someone exclaimed, "Look! Another building collapsed!" I looked at the scene of skyscrapers and dilapidated ruins outside the window, and I couldn't help but worry. Every cell around me was solemn. Maybe the next bad luck will befall us.

Figure 3 Copyright image, no permission to reprint

The news brought by the blood cells said that we had experienced "isolation". During these two weeks, we experienced the normal work and rest schedule and 8-hour work day that we dreamed of. But as the blood cell "isolation" ended, we suddenly returned to our previous frequent overtime life. The transportation pipelines of the sergeant's house kept transporting things to the factory. These things all exuded a strong smell of spicy and alcohol, waiting to be processed. Unfortunately, most of us are allergic to peppers. These peppers that came one after another stimulated us to sneeze continuously, and our whole body was straining. The factory shook three times. Alcohol is one of the few substances that can be directly absorbed by the stomach, and we suffered greatly from it.

Figure 4 Copyright image, no permission to reprint

As a result, under the stimulation of pepper and alcohol, my colleagues' bodies turned red, blisters appeared, the gastric mucosa became congested and edematous, and a large amount of gastric acid was secreted, further damaging the mucosa. Some brothers could not bear it and fell down in pain. The gastric mucosal epithelial cells, which served as the protective membrane of the stomach, died and fell off, resulting in defects on the mucosal surface. The protective shield covering our heads became tattered.

Figure 5 Copyright image, no permission to reprint

What's worse, gastric acid began to attack the unprotected cells. For a while, screams were heard everywhere. Severe pain swept through the entire "Wei". Blood gushed out on the stomach wall. At this time, a large number of neutrophils rushed into the factory to start rescue. This tragedy was called acute erosive gastritis.

Figure 6 Copyrighted images are not authorized for reproduction

II. Changes in the World - Chronic Atrophic Gastritis

In fact, I have heard too many tragedies of this kind from my elders. Every generation of various cells from the "Wei (stomach)" are eager to work hard to prevent the tragedy from happening again, but the repeated invasion of chili and alcohol makes us powerless.

I felt that the gastric mucosal epithelial cells had been killed and wounded in countless numbers. These respectable guards had turned pale under the attacks of acute erosive gastritis. The winding umbrella that had previously covered our heads was only a thin layer left, and the wrinkles on the umbrella had almost disappeared. I think the worst situation that the elders talked about has come. The same war and sacrifice have been repeated too many times. The damage day after day has made countless cells work hard to repair, but it is unsustainable. The gastric mucosa can no longer bear it and gradually atrophies.

Figure 7 Copyright image is not authorized for reproduction

3. Cleansing the old and renewing the new: intestinal metaplasia

New cells slowly appeared in the place of the fallen guards, occupying and expanding their territories with great fanfare. Some of them were cup-shaped and could secrete sticky mucus, and some had hair growing on their heads. The white blood cells that had traveled around the "Ren" country said that these were workers from the "Chang (Intestine) Company" next door. These cells had their own unique names: absorption cells, goblet cells, and Paneth cells. But why are there so many white blood cells traveling around recently?

Figure 8 Copyright image, no permission to reprint

4. Filling up the streets and alleys: intraepithelial neoplasia

These workers, shaped like intestinal epithelial cells, invaded at a speed far beyond our imagination. In a matter of days, they filled the surface space and even crushed our factories. They huddled together and threatened to turn into tumors, forming ridges on the surface of the gastric mucosa.

Figure 9 Copyright image, no permission to reprint

5. Worst Outcome: Gastric Cancer

Now, the tumorous intestinal epithelial cells have completely changed into a ferocious face. They first recruited people in the gastric mucosa, and then they were no longer satisfied with occupying the surface of the gastric mucosa, and began to infiltrate inward, thickening the stomach wall and shrinking the stomach cavity. Because their people were everywhere inside and outside the factory, we were forced into the corners of the factory, with nowhere to stay. With food shortages and a shortage of personnel, we were so hungry that we could no longer work normally. We could only watch more life and death dramas unfold around us.

Figure 10 Copyright image, no permission to reprint

If this continues, the collapse of the "Wei Factory" (stomach) is only a matter of time. The day when the factory stops operating will come sooner or later. Without normal workers, the food from the non-commissioned officers (esophagus) cannot be digested, and the Chang (intestines) can no longer transport nutrients. Hundreds of millions of cells in the "Ren" country will eventually repeat the fate of the "Wei" (stomach), and be buried under the "Five Finger Mountain" of alcoholism, overeating and disordered lifestyle.