I want to share with you a tale about forgetfulness and hurry, and how the two can combine to produce terrible results. A few years back, I remembered I hadn’t taken “my medication” as I was getting ready to turn out the light from my bed.
I was then a prescription drug user, joining over 161 million other American adults in that situation. Being a responsible person, I stood up, took the pill, and threw it away. I didn’t bother to get a glass of water to help the thing go down because I was being lazy. Instead, I quickly went back to bed, covered my head with a pillow, and got ready to sleep.
I quickly experienced a burning sensation in my chest. A minute or so later, that burn became into excruciating agony. I went into the living room so as not to wake my wife, and there I spent the next thirty minutes doubled over in pain. Was I suffering from a heart attack? I dialled my sister’s Texas hospitalist number. She suggested that I go to the emergency department by myself to get checked out.
If only I had known about “Duke” back then. He may have explained to me the need of good posture when taking medicines.
What is Duke?
Computer scientists at the IT’IS Foundation, a non-profit organisation based in Switzerland that works on a variety of initiatives in health care technology, built Duke, a computer simulation of a 34-year-old, anatomically normal human guy. Rajat Mittal, PhD, a professor of medicine at the Johns Hopkins School of Medicine in Baltimore, developed the “StomachSim” computer model using Duke to examine the digestive process.
Their study, which was published in the journal Physics of Fluids, produced a number of unexpected results about the dynamics of taking tablets, the most widely used kind of medication in the world.
According to Mittal, most other organ systems, including the heart and the brain, have received plenty of attention from scientists, so he decided to focus on the stomach.
The ramifications of stomach biomechanics on significant illnesses including diabetes, obesity, and gastroparesis “became clear to me when I was looking to launch study in some new lines,” he says. There seemed to be a great opportunity to carry out significant research because it was evident that bioengineering research in this field is at least 20 years behind that in other, more “sexy” fields like cardiovascular flows.
You Could Make a Pill Work Better by Your Posture
The contents of the stomach (a heavy breakfast, a mixture of liquids like juice, milk, and coffee), as well as the movement of the organ’s walls, are two well-known factors that affect a pill’s capacity to spread its contents into the gut and be utilised by the body. But Mittal’s team discovered that Duke’s posture was also very important.
Duke was put through computer simulations in a variety of positions, including erect, leaning right, leaning left, and leaning back, while all other aspects of their analysis (such as the ones described above) remained constant.
They discovered that up to 83% of a pill’s absorption rate into the intestines was influenced by posture. Leaning to the right was the most effective position. Leaning left was the least effective because it prevented the pill from reaching the antrum, or bottom section of the stomach, and prevented the majority of the dissolved medication from entering the duodenum, which connects the small intestine to the stomach. (Interestingly, it is recommended for Jews who observe Passover to lean to the left throughout the meal as a representation of freedom and leisure.)
If you consider how the stomach is shaped, which resembles a bean and curves from the left to the right side of the body, it makes sense. Your position will affect where the pill lands because of gravity.
In the end, the researchers discovered that gastroparesis, a disorder in which the stomach loses the ability to empty properly, can have an impact on how a pill dissolves just as much as posture.
How This Might Benefit People
According to Mittal, among the populations most likely to gain from such research are the elderly, who frequently take medications and are more likely to experience difficulty swallowing due to esophageal abnormalities brought on by ageing, and the bedridden, who find it difficult to modify their position. The discoveries might also help doctors better treat persons with gastroparesis, which is a particular issue for diabetics.
Future research with Duke and simulations of a similar nature will examine how the GI system breaks down proteins, carbs, and fatty meals, according to Mittal.
In the meanwhile, Mittal gives the following guidance: “It’s okay to stand or sit up straight after taking a tablet. If you must take a tablet while lying down, position yourself on your back or right side. After taking a medication, stay off your left side.
Any gastroenterologist who reads this would see that what occurred to me was not related to the heart. Instead, I most likely had a flare-up of pill esophagitis, an irritation that can be brought on by drugs that irritate the feeding tube’s mucosa. Esophagitis is uncomfortable but not life-threatening. The discomfort eventually subsided after about an hour, and the next morning I was OK with only a slight chest aching to serve as a reminder of my earlier suffering. Early in the COVID-19 epidemic, researchers noticed a rise in the disorder, which they connected to the medication doxycycline.
And, for completeness’ sake, my pill trouble started above the stomach. Nothing in the Hopkins study implies that the position of the esophagus affects how medications are absorbed in the gut, unless, of course, it keeps the pills from ever reaching the stomach.