In this encore episode, we detail hydrogen sulfide (H₂S)-dominant small intestinal bacterial overgrowth (SIBO), focusing on intestinal motility. We briefly review anatomy, focusing on and detailing the interplay between structures supporting motility. Lastly, we detail possible symptoms of hydrogen sulfide-dominant SIBO as well as possible overlap between or among subtypes.

Topics:

1. Introduction to Hydrogen Sulfide-Dominant SIBO 

   - Overview of hydrogen sulfide (H₂S) SIBO

   - H₂S production

- Sulfur-containing amino acids

   - Physiological roles of H₂S vs. in excess 

2. Hydrogen Sulfide and Gastrointestinal Motility 

   - Possible impact on transit

   - Possible association with IBS-like symptoms in excess

3. Anatomy: Intestinal Motility 

   - ENS as the "second brain" 

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

   - Gut-brain axis involvement

   - ICCs as pacemaker cells

   - MMC’s role in clearing debris and bacteria

4. Dysregulated Motility and SIBO

5. Overlap Across SIBO Subtypes 

   - Possible symptoms

   - Hydrogen and H₂S-dominant SIBO vs. IMO

6. Gastric Acid and Its Role

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

   - Hypochlorhydria

7. Conclusion

   - Root cause approach.

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