June 06, 2025

182. Hydrogen Sulfide Dominant Small Intestinal Bacterial Overgrowth & Gastrointestinal Motility | Contributing Factors, Symptoms, and More

13 minutes

In this encore episode, we go through the pathophysiology of hydrogen sulfide (H₂S)-dominant small intestinal bacterial overgrowth (SIBO), focusing on its role in intestinal motility disruption, microbial dysbiosis, and epithelial barrier dysfunction. We detail the interplay between the enteric nervous system (ENS), interstitial cells of Cajal (ICCs), and migrating motor complex (MMC) in regulating small intestinal transit and how excess H₂S modulates smooth muscle activity, inflammatory signaling, and gastrointestinal transit time. Lastly, we detail symptoms and related SIBO subtypes.

Topics:

1. Introduction to Hydrogen Sulfide Dominant SIBO

- Overview of hydrogen sulfide (H₂S) SIBO

- Sulfate as an electron acceptor

- H₂S production, sulfur-containing amino acids

- Physiological roles of H₂S vs. in excess

2. Hydrogen Sulfide and Gastrointestinal Motility

- Impact on transit time

- Association with IBS-like symptoms, diarrhea

3. Intestinal Motility and Regulation

- Role of the ENS, ICCs, smooth muscle cells, and neurotransmitters in motility

4. The Enteric Nervous System (ENS) and Gut Motility

- ENS as the "second brain" and its control over digestion

- Myenteric and submucosal plexuses: regulation of peristalsis, secretion, blood flow

- Gut-brain axis involvement via vagus nerve signaling

- ICCs as pacemaker cells generating slow-wave electrical activity

- MMC’s role in clearing debris and bacteria

5. Dysregulated Motility and SIBO Development

6. Overlapping Symptoms Across SIBO Subtypes

- Shared symptoms

- Hydrogen and H₂S-dominant SIBO vs. IMO

7. Gastric Acid and Its Role

- HCl secretion by parietal cells and its role in digestion and microbial defense

- Hypochlorhydria and bacterial overgrowth

8. Conclusion

- Root cause approach.

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