Tiny Device Lets Doctors Customize Medications for Your Body

Years ago, my brother was diagnosed with ulcerative colitis (UC) — chronic inflammation of the large intestine that can cause abdominal pain and bleeding, among other terrible symptoms. He had to take steroids for a long period of time to get the disease under control. It was a miserable time, not only because of the UC, but because of the side effects (including high blood pressure, fluid retention, weight gain, bone loss and more) from the ongoing steroid use. Fortunately, his illness is now under control… but when I read about a recent UC study that used some intriguing technology to examine why some of the easier-to-take medications might not work for some UC patients, I was reminded of those early days.

Pinpointing the Problem

The study was conducted by Brian Bosworth, MD, assistant professor of medicine at Weill Cornell Medical College and director of the Advanced Fellowship in Inflammatory Bowel Disease at New York Presbyterian Hospital, Weill Cornell Center, and his colleagues. It was relatively small, involving only 10 subjects, half with UC and half who were healthy. Researchers used a non-invasive bit of technology called the SmartPill — a capsule slightly larger than a vitamin pill that has the ability to measure pH, pressure and temperature in the GI tract. The patient simply swallows the pill and wears a small data receiver (either around the neck or clipped to a belt), then goes about the activities of normal life. After the pill has passed through the body (about 48 hours), he/she returns the data receiver to the physician, who downloads the collected information for study.

It is important to have this data because the majority of mesalamines, one class of drugs used to treat UC, are designed to release when the pH in the GI tract reaches level 6 or 7. Though mesalamines have fewer side effects than steroids, they are ineffective in certain people and, until now, it wasn’t clear why. The SmartPill technology showed researchers that the GI tracts of the UC patients took longer to reach the key pH of 7 than the control subjects — and their pH levels didn’t stay at 7 as long, either. It appears that the medications may not be dissolving as needed to be effective, but further studies are necessary to learn more.

A new method of treatment?

Between 30% and 60% of UC patients don’t respond to mesalamine therapy. “If we know why they didn’t respond to one mesalamine, it means we can switch to another instead of having to resort to steroids,” I was told by Ellen J. Scherl, MD, one of the researchers involved in the study. She said the doctor could then fine-tune the prescription to find one that works — and in fact, may someday be able to tailor a pharmaceutical treatment to work perfectly with an individual’s digestive system. That would be welcome news to people with UC, though much more research needs to be done first. The small-scale technology of the SmartPill could lead to big improvements in the lives of patients with UC. Just as exciting is the possibility that this tool could eventually lead to a new way of looking at how the human body handles medication in general.