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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In this episode, we detail the oral microbiome and its relationship with the intestinal microbiome, detailing the oral-gut microbiota axis. We discuss the stepwise development of oral biofilm, the transition from plaque to dental calculus, and potential systemic impacts of oral dysbiosis, while highlighting intestinal health and focusing on Fusobacterium nucleatum. We then detail possible symptoms of oral dysbiosis as well as testing modalities.

Topics:

1. Overview of the Oral Microbiome and the Oral-Gut Axis

- The oral cavity and the gut: microbially dense sites.

- These regions are anatomically distinct but connected and capable of influencing each other.

- The oral microbiome: bacterial species, fungi, viruses, archaea, protozoa.

- Microbial distribution is influenced by the topography and chemistry of various oral surfaces.

2. Oral Cavity Anatomy and Microenvironments

- The oral cavity is divided into the vestibule and oral cavity proper.

- Lined by oral mucosa, which varies in structure.

- These anatomical variations create unique ecological niches that support different microbial populations.

3. Tooth Structure and Relevance to Microbial Colonization

- Teeth are embedded in the alveolar processes of the maxilla and mandible.

- Tooth structure.

- Long-term microbial colonization and biofilm development.

4. Biofilm / Dental Plaque Development

- Biofilm begins with the formation of the acquired pellicle.

- Pioneer species secreting extracellular polymeric substances (EPS).

- Secondary colonizers coaggregate.

- Coaggregation is species-specific.

- Example.

- Aerobes can lower local oxygen levels, creating micro anaerobic niches that support obligate anaerobes.

5. Maturation of the Biofilm

- Biofilm composition shifting to anaerobic, proteolytic species such as P. gingivalis.

- F. nucleatum: a bridge species.

6. Mineralization and Formation of Dental Calculus

- Mineralization, calcium and phosphate deposition.

- Dental calculus.

- Can promote further accumulation and worsen inflammation.

7. Oral Dysbiosis

- An imbalance in the oral microbial community.

- Potential signs and symptoms.

- Halitosis, swollen or bleeding gums, tooth sensitivity, new cavities, dry mouth or altered taste, recurrent infections, coated tongue, plaque buildup near the gumline.

8. Oral-Gut Axis and Systemic Implications

- Physical, chemical, biochemical, and immunological barriers aid in preventing oral bacteria from colonizing the gut.

- Oral bacteria can potentially impact intestinal health.

- F. nucleatum and IBD.

9. Oral Microbiome Testing

10. Multi-Factorial

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