PD876 - GUT MICROBIOME, NUTRITION AND DRUGS – INTERACTIONS IN PALLIATIVE CARE PATIENTS

PD876

GUT MICROBIOME, NUTRITION AND DRUGS – INTERACTIONS IN PALLIATIVE CARE PATIENTS

I. Pawłowska^1,*, A. Modlińska ^2,3, I. Kocić¹

¹Department of Pharmacology, Medical University of Gdańsk, Gdańsk, ²St Joseph's Hospice Caritas , Sopot, ³Department of Palliative Medicine, Medical University of Gdańsk, Gdańsk, Poland

 

Rationale: Palliative care (PC) aims to improve quality of life in patients with life-threatening diseases through symptom control, often using pharmacological interventions. However, the interplay between drugs, the gut microbiome, and nutrition remains poorly understood.

Methods: A critical review of the literature was conducted using PubMed, Scopus and WoS with keywords: gut microbiota, palliative care, nutrition, food, drugs, opioids, and interactions.

Results: Bidirectional interactions were identified across the following three axes:

Drugs ↔ Microbiome

The gut microbiome is influenced by medications, while also modulating drug action and toxicity (pharmacomicrobiomics). In PC drugs such as proton pump inhibitors (PPIs), non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol, selective serotonin reuptake inhibitors (SSRIs), opioids, and laxatives can alter microbiota composition. NSAIDs shift the balance from Gram-positive to Gram-negative bacteria, contributing to intestinal injury. Opioids impair motility, immune function, and bile flow, while PPIs reduce microbial diversity and promote “oralization” of the gut microbiota.

Microbiome ↔ Nutrition

Proper nutrition is essential for maintaining gut microbiota diversity and growth. In PC, anorexia – cachexia syndrome may impair nutritional status. A balanced, high-fiber diet enriched with probiotics and low in fat may support the gut microbiome.

Nutrition ↔ Drugs

Food may reduce drug bioavailability or delay onset of action; for example, NSAIDs and paracetamol maintain bioavailability, but food prolongs their onset of action. Conversely, drugs may affect nutrition – opioids can cause nausea and reduce appetite, while tricyclic antidepressants may increase appetite.

Conclusion: Three interacting axes: nutrition, drugs, and the gut microbiome can be identified in PC. Understanding these relationships is essential for a proper approach to patient care.

Disclosure of Interest: None declared