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September 16, 2022 – I want to tell you a story about forgetfulness and haste and how the combination of the two can lead to frightening consequences. A few years ago I was lying in bed and about to turn off the light when I realized I had forgotten to take “my pill”.
Like about 161 million other American adults, I was a prescription drug user at the time. I conscientiously got up, took out said pill and threw it back. Being lazy, I didn’t bother to get a glass of water to help the thing come down. Instead, I immediately returned to bed, threw a pillow over my head, and prepared for sleep.
Within seconds I began to feel a burning sensation in my chest. After about a minute, that burn turned into a debilitating pain. Not wanting to upset my wife, I went into the living room, where I spent the next 30 minutes writhing in pain. did i have a heart attack I called my sister, a hospital doctor in Texas. She advised me to go to the emergency room to be checked out.
If only I had known about “Duke” back then. He could have told me how important posture is when people are swallowing pills.
Who is Duke?
Duke is a computer representation of a 34-year-old, anatomically normal human created by computer scientists at the IT’IS Foundation, a non-profit group based in Switzerland working on a variety of health technology projects. With the help of Duke, Dr. Rajat Mittal, a professor of medicine at the Johns Hopkins School of Medicine in Baltimore, used a computer model called “StomachSim” to study the digestive process.
Her research, published in the journal Physics of Liquids, brought some surprising insights into the dynamics of pill swallowing – the world’s most common way of taking medication.
Mittal says he decided to study the stomach because the functions of most other organ systems, from the heart to the brain, have already attracted a lot of attention from scientists.
“As I was about to start research in some new directions, the impact of gastric biomechanics on important diseases like diabetes, obesity and gastroparesis became clear to me,” he says. “It was clear that biotechnology research in this area was lagging other ‘sexy’ areas like cardiovascular flow by at least 20 years, and there seemed to be a great opportunity to do impactful work.”
Your posture can help a pill work better
Several known things affect a pill’s ability to distribute its contents in the gut and be used by the body, such as: B. the contents of the stomach (a hearty 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 big part.
The researchers ran Duke through computer simulations in various postures: upright, tilted right, tilted left, and reclined, while keeping all other parts of their analyzes (like the things above) the same.
They found that posture accounts for up to 83% of how quickly a pill spreads through the gut. The most efficient position was leaning to the right. The slightest leaned to the left, preventing the pill from reaching the antrum, or lower part of the stomach, and thus preventing all but traces of the dissolved drug from reaching the duodenum, where the stomach joins the small intestine. (Interestingly, Jews celebrating Passover are advised to lean to the left while eating as a symbol of freedom and leisure.)
This makes sense when you think of the shape of the abdomen, which looks like a bean and curves from the left to the right side of the body. Due to gravity, your position will change where the pill lands.
In the end, the researchers found that posture can be as important a factor in dissolving a pill as gastroparesis, a condition in which the stomach loses its ability to empty itself properly.
How this could help people
Among the groups most likely to benefit from such studies, Mittal says, are the elderly — both of whom take lots of pills and are more prone to swallowing problems because of age-related changes in their esophagus — and those bedridden, who can’t easily change their posture. The findings could also lead to improvements in treating people with gastroparesis, a particular problem for people with diabetes.
Future studies using Duke and similar simulations will examine how the GI system digests proteins, carbohydrates, and fatty meals, Mittal says.
Meanwhile, Mittal offers the following advice: “It’s fine to stand or sit up straight after taking a pill. If you have to 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.”
What happened to me, every gastroenterologist reading this has found that my condition is not heart related. Instead, I was probably having an attack of tablet esophagitis, irritation that can result from drugs that aggravate the lining of the esophagus. Although painful, esophagitis is not life threatening. After about an hour the pain started to subside and the next morning I was fine, only a faint pain in my chest reminding me of my earlier torments. (Researchers noted an increase in the condition, which has been linked to the antibiotic doxycycline, early in the COVID-19 pandemic.)
And, in the interests of accuracy, my pill problem began Above the stomach. Nothing in the Hopkins research suggests that the orientation of the esophagus plays a role in how drugs circulate in the gut — unless, of course, it prevents those pills from getting to the stomach in the first place.
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