September 16, 2022 – I want to tell you a story about forgetting and haste, and how the combination of the two can have frightening consequences. A few years ago, I was lying in bed about to turn off the light when I realized I had forgotten to take “my pill”.
Like some 161 million other American adults, I was then a prescription user. medication. Being conscientious, I got up, retrieved said pill and sent it back. Being lazy, I didn’t bother to get a glass of water to help the thing down. Instead, I quickly returned to bed, threw a pillow over my head, and prepared to sleep.
Within seconds I started to feel a burning sensation in my chest. After about a minute, that burning turned into an incapacitating pain. Not wanting to alarm my wife, I went into the living room, where I spent the next 30 minutes doubled over in agony. Did I have a heart attack? I phoned my sister, a hospitalist in Texas. She advised me to go to the emergency room for treatment.
If only I had known about “Duke” then. He could have told me how critical body posture is when people swallow pills.
Who is Duke?
Duke is a computer representation of an anatomically normal 34-year-old man created by computer scientists at IT’IS Foundation, a non-profit group based in Switzerland that works on a variety of health technology projects. Using Duke, Rajat MittalPhD, a professor of medicine at Johns Hopkins School of Medicine in Baltimore, created a computer model called “StomachSim” to explore the process of digestion.
Their research, published in the journal Fluid Physics, made several startling discoveries about the dynamics of pill swallowing – the most common way drugs are used in the world.
Mittal says he chose to study the stomach because the functions of most other organ systems, from the heart to the brain, have already attracted a lot of scientific attention.
“As I sought to launch research in new directions, the implications of the biomechanics of the stomach on important conditions such as diabetes, obesity and gastroparesis became obvious to me,” he says. “It was clear that bioengineering research in this area was at least 20 years behind other, sexier areas such as cardiovascular flow, and there seemed to be a great opportunity to do some work. impactful.”
Your posture can help a pill work better
Several well-known things affect a pill’s ability to disperse its contents in the intestine and be used by the body, such as stomach contents (a heavy breakfast, a mixture of liquids such as juice, milk and coffee) and the movement of the organ walls. But Mittal’s group learned that Duke’s posture also played a major role.
The researchers ran Duke through computer simulations in different postures: standing, leaning right, leaning left, and leaning back, while keeping all other parts of their scans (like the things mentioned above) the same.
They found that posture determined up to 83% of how quickly a pill disperses through the intestines. The most effective position was leaning to the right. The minus was tilted to the left, which prevented the pill from reaching the antrum, or the lower part of the stomach, and thus prevented all traces of dissolved medicine from entering the duodenum, where the stomach joins the small intestine. (It is interesting to note that Jews who observe the Passover are asked to tilt left during the meal as a symbol of freedom and leisure.)
This makes sense if you think about the shape of the stomach, which looks a bit like a bean, curving from left to right of the body. Due to gravity, your position will change to where the pill lands.
Ultimately, the researchers found that posture can be as big a factor in dissolving a pill as gastroparesis, a condition in which the stomach loses the ability to empty itself properly.
How it could help people
Among the groups most likely to benefit from such studies, Mittal says, are the elderly – who take a lot of pills and are more prone to difficulty swallowing due to age-related life changes. esophagus – and the bedridden, who cannot easily change posture. The results may also lead to improvements in the ability to treat people with gastroparesisa particular problem for people with diabetes.
Future studies with Duke and similar simulations will look at how the gastrointestinal system digests protein, carbohydrates and fatty meals, Mittal says.
In the meantime, Mittal offers the following advice: “Standing or sitting up straight after taking a pill is fine. If you must take a pill while lying down, stay on your back or on your right side. Avoid lying on your left side after taking a pill.
As for what happened to me, any gastroenterologist reading this understood that my condition was not heart related. Instead, I probably had access from esophagitis pill, irritation that may result from drugs that aggravate the lining of the food pipe. Although painful, esophagitis is not life threatening. After about an hour the pain started to subside and the next morning I was fine, with only a slight pain in my chest to remind me of my earlier torment. (Researchers noted an increase in the condition early in the COVID-19 pandemic, linked to the antibiotic doxycycline.)
And, for the sake of accuracy, my pill problem began above the stomach. Nothing in Hopkins’ research suggests that the alignment of the esophagus plays a role in how drugs disperse through the gut — unless, of course, it blocks those pills from reaching the stomach. in the first place.