In today's episode, we detail the enteric nervous system and regulation of gastrointestinal motility. We discuss factors including dysautonomia, stress, microbial overgrowth, and more, with regards to potential effects upon gastrointestinal motility. We further detail symptoms of altered GI motility.

Topics:

1. Introduction to Gastrointestinal Motility

- Orchestrated contraction of smooth muscles that propel contents along the digestive tract. 

- Roles in mixing, absorption, and preventing bacterial overgrowth.

- Disruptions in motility.

2. The Enteric Nervous System (ENS) and Its Role

- Myenteric and submucosal plexus.

- Coordinating contractions and relaxations for effective motility.

- Mucosa includes epithelium, lamina propria, and muscle. 

- Submucosa houses the submucosal plexus. 

- Muscularis externa.

- Inner circular and outer longitudinal muscle layers with the myenteric plexus in between. 

3. The Role of Interstitial Cells of Cajal (ICCs)

- Specialized pacemaker cells in muscular layers 

- Generate slow-wave electrical activity to synchronize smooth muscle contractions 

- Critical for peristalsis.

- Work with neural inputs to fine-tune gut motility 

4. Dysautonomia and Its Impact on Gut Motility

- Dysfunction of the autonomic nervous system (ANS) 

- Motility impacts

- Microbial overgrowth, SIBO

5. Gastrointestinal Dysmotility

- Neurological dysregulation

- Structural abnormalities and smooth muscle dysfunction 

- Hormonal imbalances

- Microbial overgrowth

- Autoimmunity

6. The HPA Axis

- Hypothalamus, pituitary gland, adrenal glands 

- Central to the stress response and interlinked with gut function 

- The amygdala and PVN of the hypothalamus 

- CRH stimulates ACTH, leading to cortisol release from adrenal glands 

7. Cortisol and Gut Barrier Function

- Cortisol is a glucocorticoid that modulates immune function and gut physiology 

- Chronic cortisol exposure can impair tight junction (TJ) integrity 

- Increases paracellular permeability and allows passage of antigens and endotoxins 

8.Stress-Induced Changes in Gut Motility

- Slow gastric motility 

- Increased colonic motility 

9. Symptoms of GI Dysmotility

10. Addressing Root Cause(s)

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