161. Gastrointestinal Dysmotility | Motility in Intestinal Methanogen Overgrowth & Small Intestinal Bacterial Overgrowth, and a Brief Discussion of Low Stomach Acid, Hypochlorhydria

In this episode, we explore some of the neural and cellular mechanisms underlying gastrointestinal motility, emphasizing the roles of the enteric nervous system (ENS) and interstitial cells of Cajal (ICCs) in coordinating smooth muscle contractions throughout the digestive tract. We detail disruptions in motility seen in dysautonomia, intestinal methanogen overgrowth (IMO), and small intestinal bacterial overgrowth (SIBO). And, we finish with a brief discussion on the impacts of low stomach acid.

Topics:

1. Introduction to Gastrointestinal Motility

- Coordinated contractions of smooth muscle that move food, liquid, and waste through the gastrointestinal (GI) tract.

- Neural, hormonal, and microbial factors.

- Intestinal methanogen overgrowth (IMO) and small intestinal bacterial overgrowth (SIBO).

2. Neural Regulation of Gut Motility

- The enteric nervous system (ENS) embedded in the walls of the GI tract.

- The ENS, central nervous system (CNS), and vagus nerve.

- The myenteric plexus governs motor control and peristalsis, while the submucosal plexus regulates secretion, absorption, and blood flow.

- Stress and motility

3. Cellular Regulation of Gut Motility

- Interstitial cells of Cajal (ICCs), pacemaker cells located near smooth muscle cells.

- ICCs generate slow-wave electrical activity.

- Acetylcholine enhances smooth muscle contraction.

4. Dysmotility and Potential Contributing Factors

- Impaired ICC function, smooth muscle dysfunction, nervous system dysfunction.

- Dysautonomia, a dysfunction of the autonomic nervous system.

- External stressors, hormonal imbalances, and more.

5. Intestinal Methanogen Overgrowth (IMO)

- Characterized by an overgrowth of methane-producing archaea in the intestines.

- Excess methane production affects smooth muscle activity and can slow intestinal transit.

- Symptoms such as bloating, abdominal discomfort, constipation.

- Breath testing.

6. Small Intestinal Bacterial Overgrowth (SIBO)

- Excessive bacterial colonization in the small intestine, disrupting normal gut function.

- Protective mechanisms including stomach acid and intestinal motility.

- Low stomach acid (hypochlorhydria) reduces the acidic environment needed to inhibit bacterial colonization.

- Bloating, diarrhea/constipation, and more.

7. Overlap Between IMO and SIBO

- Excess hydrogen produced in SIBO can serve as a substrate for methane production in IMO.

- Can exacerbate each other, creating a loop that worsens symptoms.

8. Addressing Dysmotility and Overgrowth

- Determining the root cause of dysmotility.

- Dysmotility can involve multiple regions of the GI tract.

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