Gut motility

Gut motility is very important for SIBO sufferers to understand. Addressing gut motility issues may lessen the chance of reoccurrence significantly. Gut motility issues can sometimes be what caused SIBO to occur in the first place.

What is gut motility?

Think of your gut like a complicated pipeline. We want things to move through it in a forward movement. That is crucial for SIBO sufferer to understand, but it’s also very important for gut health in general.

In a gut with normal gut motility, it isn’t until the large intestine things should start to slow down. SIBO sufferers do not need a slower transit time through their small intestine. That gives the excess number of bacteria an extended period to go to work, causing you tremendous pain and bloating.

After either antibiotics or scientifically researched herbals, addressing gut motility issues may stop relapse.

Think of it like this, your small intestine should have some bacteria, not a lot, but a small amount. If you have very poor gut motility and food sits there too long, bacteria will do what they do best, start to metabolise it and grow in number (all over again). That may have been what caused your SIBO in the first place and maybe why your treatment only works for a short period.

When things reach the large intestine, things naturally slow down. That is where we will dehydrate the remnants of the food we consume (now called chyme), so they come out as healthy, easy to pass stools.

What factors contribute to gut motility?

A quick overview:

Here are the key factors that keep your gut moving and your gut motility healthy:

1. Peristalsis – This action pushes your food down the gastrointestinal tract after you eat. This happens via the smooth muscle in the walls of your digestive tract contracting and relaxing. They are controlled by your interstitial cells (cajal or ICC for short). The muscles behind the food (now called a food bolus) contract, and then the muscles in front relax in front pushing food onwards.[1]

2. Segmentation – This mixes the contents of the gut and the digestive juices that help us break food down further. That helps make things easier to move, but this doesn’t contribute to the forward movement. Think of the role of segmentation like this- big bricks are hard to kick down the street, but tiny pebbles move with far less effort. That is what segmentation does for your gut. It makes it easier for peristalsis to do its job and push things on at a healthy rate.[2]

3. The migrating motor complex (MMC): acts as the house cleaner for the small intestine. The MMC is kicked into action when you haven’t eaten in a while. It’s a distinct pattern of electromechanical activity that occurs in a fasted state. Motilin, a polypeptide manufactured by endocrine cells in the small intestine, facilitates this. The MMC is vital to good gut health.[3]

Sufferers from SIBO should not underestimate the importance of the MMC. Starting right up at the stomach, the MMC sweeps through the small intestine, clearing remnant chyme and excess bacteria. SIBO suffers and needs those excess bacteria to stay healthy at a health level (without overgrowth), so they don’t end up back at square one.

There are many things that impair gut motility besides SIBO. Gastroparesis, oesophageal spasms and lifestyle factors like using nicotine and high stress can have negative impacts on gut motility.*

Treating gut motility issues – the options

Just as SIBO sufferers have options between drugs and natural supplements to kill off the small intestinal bacterial overgrowth, they have those options with gut motility issues.

Treating gut motility issues with drugs

Some of the most common drugs used to address gut motility are:

• Metoclopramide (Maxolon)
• Domperidone (Motilium)

Here is a list of some others:

• Benzamide
• Domperidone
• Itopride
• Mosapride – [13]
• Metoclopramide
• Prucalopride – [13]
• Renzapride
• Tegaserod
• Mitemcinal
• Levosulpiride
• Cinitapride
• Linaclotide

How do gut motility drugs work?

Prokinetic agent drugs work by enhancing gut motility. They do this by increasing the strength or frequency of the earlier contractions without disrupting the rhythm.

They may be beneficial for SIBO sufferers with slow gut motility as a root cause.

They can assist food in moving through the small intestine. Your doctor may prescribe these if you have frequent reoccurrences and clear signs of slowed gut motility.

What are they used for?

These drugs are often used to treat the following gastrointestinal issues that many SIBO sufferers experience:

• Bloating
• Constipation
• Heart burn
• Nausea and/or vomiting

They are also used to treat other gastrointestinal disorders such as:

• “IBS” (of which we know a large % is attributed to SIBO)
• Gastritis
• Gastroparesis
• Functional dyspepsia

Natural or herbal medicine for gut motility

The last thing we want to do is flush money down the toilet in the name of good marketing.

With that said, there are some fantastic supplements you can use that have been researched and proven effective by the scientific and medical community.

Globe Artichoke – prokinetic herb

Globe artichoke has also been shown to reduce serum cholesterol, hepatoprotective, and antispasmodic effect.

An antispasmodic effect helps relax the gut muscles so food can move on more quickly.

Globe artichoke is frequently formulated with ginger, the next natural prokinetic we will touch on. Where ginger acts on the stomach, globe artichoke appears to act on the motility of the small intestine.

The thinking here is that the increase in bile acids help increase how quickly food can move through the small intestine.[4]

Globe artichoke and SIBO

For individuals suffering with SIBO or with a history of SIBO, we can see why this may be beneficial supplement to consider. Less time in the small intestine means less time for the bacteria to metabolise the food that passes through.

Globe Artichoke tends to increase the motility of the small intestine by increasing bile acids. That may be beneficial to SIBO sufferers who may have weaker contractions than average as food will be pushed forward with less effort from the smooth muscle in the small intestine.

Ginger – prokinetic herb

Ginger has been shown to help stimulate motility in the digestive tract[5] and has been used to treat digestion for some time. It also has other beneficial properties, such as stimulating circulation and inflammation-modulating and contains anti-viral properties.

Data from the scientific literature has shown that ginger can help to accelerate gastric emptying.[6] It tends to work more so on accelerating stomach emptying than the small intestine. This still might be helpful to SIBO sufferers who believe slow motility or delayed stomach emptying maybe a root cause of their SIBO or SIBO reoccurrence.

*More on smoking and gut motility here if you’re interested: https://pubmed.ncbi.nlm.nih.gov/8536520/ But in summary, smoking (likely just nicotine) has a marked negative impact on gastric motility, and a person dependent (3/10) impact on duodenal motility.

¹ Kumral and Zfass
² Kumral and Zfass
³ Kumral and Zfass
⁴ Giacosa et al.
⁵ Nikkhah Bodagh et al., “Ginger in Gastrointestinal Disorders: A Systematic Review of Clinical Trials”
⁶ Hu et al.