Prokinetics and SIBO Relapse Prevention

Prokinetics and SIBO Relapse Prevention — scientific infographic poster
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Table of Contents

  1. How Often SIBO Comes Back
  2. Meet the Migrating Motor Complex (MMC)
  3. What Breaks the MMC
  4. Meal Spacing and the MMC
  5. Prescription Prokinetics
  6. Herbal Products Studied for Motility
  7. How Practitioners Time Prokinetics After SIBO Treatment
  8. Lifestyle Factors and the Evidence
  9. Root Causes and Relapse
  10. What the Research Shows
  11. Key Research Papers
  12. Featured Videos

1. How Often SIBO Comes Back

SIBO treatment usually means a course of rifaximin, an elemental diet, or several weeks of herbal antimicrobials such as berberine and oregano oil. For many people the breath test then comes back clean and the bloating eases.

In many cases SIBO then returns. In one follow-up study, 80 patients whose glucose breath test had normalized after one week of rifaximin were retested over 9 months: 12.6% were positive again at 3 months, 27.5% at 6 months and 43.7% at 9 months (Lauritano 2008).

The factors linked to recurrence in that study were older age, a past appendectomy and long-term use of proton pump inhibitors (PPIs). In patients whose breath test turned positive again, gastrointestinal symptoms returned as well.

A common way of putting this in SIBO care is that clearing the bacteria without addressing why they accumulated is like mopping the floor while the faucet still runs. This article covers one part of that picture: the small intestine's fasting cleaning wave, the migrating motor complex, and the drugs and habits proposed to support it.

2. Meet the Migrating Motor Complex (MMC)

The small intestine has a cleaning cycle. During fasting, a wave of coordinated muscular contractions starts in the stomach or duodenum and migrates down the small intestine toward the ileocecal valve. This is the migrating motor complex (MMC). It recurs at roughly 90-120 minute intervals during fasting and is interrupted by eating (Deloose 2012; Mondal 2017).

The MMC is described in four phases. Phase III is the most active: a burst of strong contractions that begins in the stomach or duodenum and travels down the gut (Deloose 2012). The pattern has long been called the gut's “housekeeper”, sweeping residual food and bacteria onward toward the colon, and disturbances in it have been associated with small intestinal bacterial overgrowth (Deloose 2016).

A rough analogy is a dishwasher rinse cycle: if it never runs, the dishes pile up. Reviews link an absent MMC with gastroparesis, intestinal pseudo-obstruction and small intestinal bacterial overgrowth (Deloose 2012).

Human recordings support the link. In a manometry study from Pimentel's group at Cedars-Sinai, 68 people with IBS and an abnormal lactulose breath test averaged 0.7 phase III events during 4 hours of fasting, against 2.2 in 30 controls, and those whose overgrowth was still present at the time of testing had fewer phase III events than those whose overgrowth had been eradicated (Pimentel 2002). The MMC is one of several defences usually listed against overgrowth, alongside gastric acid, the ileocecal valve and intestinal immunity.

3. What Breaks the MMC

The small-bowel MMC is run mainly by the gut's own nervous system, the interstitial cells of Cajal (the intestinal “pacemaker” cells) and signals such as motilin and serotonin. The vagus nerve's role appears limited to the stomach: cutting it abolishes the stomach's MMC activity but leaves the periodic activity of the small bowel intact (Deloose 2012). Conditions linked to disturbed motility or to SIBO include:

Eating is the everyday interruption. The MMC runs only in the fasting state, and a meal switches the small bowel into its fed pattern (Deloose 2012). In healthy volunteers, even a 220 kcal meal kept the small bowel in its fed pattern for nearly 3 hours (Schönfeld 1997).

4. Meal Spacing and the MMC

Meal spacing is a staple of practitioner advice for SIBO relapse prevention. It rests on motility physiology rather than on trials that measured SIBO relapse.

The usual version is three meals a day, spaced 4-5 hours apart, with no snacks between them.

The physiology behind it: after a meal the small bowel stays in its fed pattern for hours, and longer the more calories the meal holds. In eight healthy men, fed activity lasted about 2.8 hours after a 220 kcal lunch, about 5 hours after 440-660 kcal and about 6.6 hours after 1,100 kcal, with no difference between day and night (Schönfeld 1997). Only after that does the fasting cycle resume. On a day of breakfast at 7, a snack at 10, lunch at 12, another snack at 3, dinner at 6 and crackers at 9, the small bowel can spend nearly all its waking hours in the fed pattern, leaving little or no time for a daytime phase III sweep. By the same figures, a 4-5 hour gap after a larger meal may close before the fed pattern has ended, which leaves the overnight fast as the main fasting window for many people.

Practitioner lists of what fits between meals usually include water, plain black coffee and unsweetened tea, on the reasoning that anything with calories, even cream in coffee or a splash of juice, starts a new fed period. Chewing gum is often listed as a problem too, but chewing alone has been tested: in eight healthy people, sham feeding (chewing and tasting food without swallowing it) raised gastrin and neurotensin levels but did not disrupt the MMC (Soffer 1992).

Overnight is the longest fast of the day, and ambulatory recordings capture MMC cycles through the night (Husebye 1992; Scott 2006). A 12-14 hour overnight fast, a common practitioner target, leaves several hours of fasting cycles once the evening meal's fed pattern has ended; the number of cycles depends on the size of that meal and varies considerably even within the same person (Scott 2006).

Two timelines of the small bowel’s motor pattern. Hours after one meal: the fed pattern lasted about 2.8 hours after 220 kcal, about 5 hours after 440 to 660 kcal and about 6.6 hours after 1,100 kcal (Schönfeld 1997), so a next meal 4 to 5 hours later can arrive before a larger meal’s fed pattern has ended. Two schematic days, one of three 440 to 660 kcal meals 5 hours apart and one of meals at 7, 12 and 6 plus snacks at 10, 3 and 9, both stay in the fed pattern through the waking hours; the Phase III sweeps of the migrating motor complex, recurring about 90 to 120 minutes apart, appear only overnight, once the last fed pattern has ended, which on the spaced day falls inside a 14 hour overnight fast. A bar shows the 43.7 percent of 80 patients in one rifaximin study whose breath test was positive again at 9 months (Lauritano 2008). THE CLEANING WAVE WAITS FOR THE FED PATTERN TO END the migrating motor complex (MMC) runs only in the fasting state; a meal switches the small bowel to its fed pattern HOURS AFTER ONE MEAL: FED PATTERN BY MEAL SIZE next meal at 4–5 h 220 kcal440–660 kcal1,100 kcal ~2.8 h~5 h~6.6 h 1234567 hours after meal THREE MEALS 5 H APART, EACH 440–660 KCAL 5 h5 h14 h overnight fast MEALS AT 7, 12, 6 + SNACKS AT 10, 3, 9 little or no time for a daytime sweep 7 am1 pm7 pm1 am7 am meal snack fed pattern fasting Phase III sweep WHAT THE TIMING DATA SHOW sweeps return only after the fed pattern fed activity lasted ~2.8 h after 220 kcal, ~5 h after 440–660 kcal and ~6.6 h after 1,100 kcal, day or night (Schönfeld 1997) a 4–5 h gap may close before it ends after a larger meal, so the overnight fast is the main fasting window for many people fasting cycles recur ~90–120 min apart (Deloose 2012; Mondal 2017); how many fit overnight depends on the evening meal and varies within one person (Scott 2006) RELAPSE AFTER RIFAXIMIN 43.7% breath-test positive at 9 months all 80 patients (Lauritano 2008) meal spacing rests on motility physiology, not on trials that measured SIBO relapse schematic day rows: meals drawn at 440–660 kcal (~5 h), snacks at 220 kcal (~2.8 h) · sweep positions are not measured

5. Prescription Prokinetics

Prokinetics are drugs that stimulate gut contractions; some, such as erythromycin, can trigger a phase III burst directly. They differ from laxatives, which act mainly on the colon and stool. Practitioners use them after SIBO treatment on the reasoning that stronger fasting motility lowers the chance of relapse; the evidence for that is summarized in section 10.

Low-Dose Erythromycin

Erythromycin is a macrolide antibiotic that also acts as a motilin receptor agonist. Motilin levels rise and fall with the MMC, and motilin induces phase III contractions that start in the stomach (Deloose 2016); intravenous erythromycin does the same in humans (Deloose 2012). In healthy volunteers, a low intravenous dose induced a phase III in the stomach in every subject within about 13 minutes, while a higher dose produced strong antral pressure waves instead of a phase III (Björnsson 1995). The SIBO relapse study described in section 10 used 50 mg by mouth at bedtime (Pimentel 2009), and a gastroparesis study used 50-100 mg doses (Dhir 2004), well below antibiotic doses.

In that SIBO study, erythromycin's result did not reach statistical significance against no prevention (section 10). Tachyphylaxis, a loss of effect with continued use, is a recognized issue in other conditions: in a gastroparesis study using antibiotic-range oral doses, 48% of a solid meal remained in the stomach at 2 hours after 4 weeks of treatment, against 20% after a single intravenous dose and 85% at baseline (Richards 1993), and a low-dose gastroparesis study found long-term responses weaker than short-term ones, possibly from tachyphylaxis (Dhir 2004). Some practitioners cycle erythromycin on and off for this reason; such schedules are practitioner conventions rather than trial-tested regimens.

Erythromycin also prolongs cardiac repolarization. In a large Tennessee Medicaid cohort, current users of oral erythromycin had twice the rate of sudden cardiac death of non-users, and five times the rate when it was taken together with drugs that block its breakdown by the CYP3A enzyme, such as diltiazem, verapamil or certain antifungals (Ray 2004). That cohort involved antibiotic courses, at higher doses than motility regimens.

Prucalopride

Prucalopride is a selective, high-affinity 5-HT4 receptor agonist (Tack 2009). In 40 people with constipation, 7 days of prucalopride accelerated gastric emptying and small-bowel transit, with significantly faster colonic transit at the 4 mg dose (Bouras 2001). The FDA approved it in 2018 for chronic idiopathic constipation in adults (US prescribing information). It is discussed for methane-dominant overgrowth (IMO) because methane slows transit: in dogs, methane infused into the small intestine slowed transit by an average of 59% (Pimentel 2006, animal study). Its use in SIBO or IMO rests on this motility rationale rather than on SIBO trials.

Older 5-HT4 drugs ran into heart problems: cisapride was restricted or withdrawn over QT prolongation (Keller 2010), and tegaserod was withdrawn in 2007 over cardiovascular events (Sayuk 2022). In a 4-week safety trial in 89 nursing-home residents (mean age 83, 88% with a history of cardiovascular disease), prucalopride at up to 2 mg a day showed no differences from placebo in the ECG QT interval or in arrhythmias on Holter monitoring (Camilleri 2009).

The US label dose for adults is 2 mg once daily, or 1 mg once daily with severe kidney impairment. The main constipation trial tested 2 mg and 4 mg once daily for 12 weeks; headache and diarrhoea were the most frequent treatment-related side effects (Tack 2009).

Low-Dose Naltrexone (LDN)

Naltrexone at full dose (50 mg) is an opioid receptor blocker used in addiction medicine. “Low-dose” use in the published gastrointestinal studies ranges from 0.5 mg to 4.5 mg a day (Kariv 2006; Ploesser 2010). The proposed mechanisms come mainly from preclinical work and remain hypotheses: a very low dose blocking excitatory opioid signalling without affecting inhibitory signalling (Kariv 2006), and dampening of microglia, the nervous system's immune cells (Younger 2009).

Low doses are not sold as a standard tablet, so LDN is usually prepared by a compounding pharmacy. The evidence in gut disorders comes from uncontrolled studies. In an open-label pilot, 42 people with IBS took 0.5 mg a day for 4 weeks; 76% improved on a global assessment and there were no significant adverse reactions (Kariv 2006). In a mailed survey of one gastroenterologist's patients (121 responders), 61% reported side effects, most often neurological, 27% of those with side effects stopped the drug, and 15 of 85 patients with IBS and SIBO reported marked improvement (Ploesser 2010). In a fibromyalgia pilot, side effects including insomnia and vivid dreams were rare, minor and transient (Younger 2009).

Tegaserod

Tegaserod is a 5-HT4 agonist. It was withdrawn from the US market in 2007 over concerns about cardiovascular events and re-approved in April 2019 with a narrower label: IBS with constipation in women under 65 without heart disease or additional cardiovascular risk factors (Sayuk 2022). The FDA's Drugs@FDA database now lists the product as discontinued. Tegaserod produced the strongest result in the retrospective SIBO relapse study described in section 10 (Pimentel 2009).

Metoclopramide / Domperidone

Older prokinetics. Metoclopramide, a dopamine receptor antagonist that crosses the blood-brain barrier, can cause tardive dyskinesia, a movement disorder that can be irreversible; in 2009 the FDA added a boxed warning about long-term or high-dose use, and a review estimated the risk as likely under 1% (Rao 2010). Domperidone is not approved for human use in the United States. The FDA states that it cannot be legally compounded, that US access has been limited to an expanded-access program for severe gastrointestinal conditions, which it said would end when its supplier's stock ran out in September 2025, and that its serious risks include cardiac arrhythmias, cardiac arrest and sudden death, linked to its blood level. Neither drug has been studied in trials of SIBO relapse prevention.

6. Herbal Products Studied for Motility

Several herbal products are used by people who cannot access or tolerate prescription prokinetics. Their evidence comes mainly from functional dyspepsia and IBS trials and short gastric-emptying studies; none of the trials below measured SIBO relapse.

STW 5 (Nine-Herb Liquid Preparation)

STW 5 is a German liquid herbal preparation combining nine botanicals: Iberis amara (bitter candytuft), peppermint, chamomile, caraway, lemon balm, angelica, greater celandine, milk thistle and licorice. A meta-analysis of three placebo-controlled functional dyspepsia trials found it more effective than placebo on the most bothersome symptom (Melzer 2004), and in a 208-patient IBS trial it reduced abdominal pain and IBS symptom scores more than placebo at 4 weeks (Madisch 2004). Its measured motility effects are in the stomach: in healthy men, a single dose relaxed the upper stomach and increased antral contractions without changing pyloric or duodenal pressures or the emptying of solids (Pilichiewicz 2007). Some integrative practitioners use it after SIBO treatment.

One of its herbs, greater celandine, has been linked to liver injury: a 2012 review of 16 published European cases of liver injury attributed to greater celandine extracts found jaundice with high liver enzymes in virtually all of them, and a favourable outcome despite a severe course (Teschke 2012).

Ginger

Ginger (Zingiber officinale) speeds stomach emptying in small studies. In 24 healthy volunteers, 1.2 g of ginger taken an hour before a test meal gave a stomach half-emptying time of 13.1 minutes against 26.7 minutes with placebo and increased antral contractions, without changing symptoms (Wu 2008). The same dose in 11 people with functional dyspepsia gave a median half-emptying time of 12.3 minutes against 16.1 minutes with placebo, with no change in symptoms or in motilin and ghrelin levels (Hu 2011). In laboratory tests, ginger's gingerols and shogaols weakly blocked 5-HT3 receptors and showed no 5-HT4 activity (Pertz 2011). These studies measured the stomach, not the small-bowel MMC.

Berberine

Berberine is used in herbal SIBO antimicrobial protocols, but the human motility data point away from a prokinetic effect: in 20 healthy volunteers, a 1.2 g dose slowed small-intestinal transit from about 71 to 98 minutes, which the authors linked to its antidiarrheal action (Yuan 1994). In a pair of diabetes studies, 0.5 g three times a day for 3 months lowered blood glucose about as much as metformin in the randomized comparison, and about a third of patients taking it had transient gastrointestinal side effects (Yin 2008), which raises a concern for people already taking glucose-lowering drugs.

Triphala

Triphala is an Ayurvedic formula of three fruits, amalaki, bibhitaki and haritaki, traditionally used for digestive complaints. Its use as a bedtime “prokinetic” comes from practitioner practice rather than motility studies; controlled human research is small, such as a 4-week pilot in which healthy adults took 2,000 mg a day and the outcome was gut bacterial composition, not motility (Peterson 2020).

Ginger and Artichoke Combinations

Combination capsules sold for MMC support often pair ginger with artichoke leaf extract, sometimes with other ingredients. A standardized ginger-plus-artichoke extract has two small trials. In 126 people with functional dyspepsia, two capsules a day before lunch and dinner for 4 weeks improved nausea, epigastric fullness, epigastric pain and bloating more than placebo (Giacosa 2015). In 11 healthy volunteers, one capsule before a meal left the stomach about 24% smaller than with placebo an hour later, which the authors read as faster emptying (Lazzini 2016). Both studies included authors from the extract manufacturer's research unit, and neither looked at SIBO.

7. How Practitioners Time Prokinetics After SIBO Treatment

SIBO-focused practitioners commonly describe the following timing. Apart from the retrospective study in section 10, these are practitioner conventions rather than trial-tested regimens.

8. Lifestyle Factors and the Evidence

The evidence behind these ranges from direct measurements of stomach emptying to practitioner reasoning; none of the studies below measured SIBO relapse.

9. Root Causes and Relapse

Prokinetics act on motility; they do not remove the underlying reason motility failed. Root-cause workups described by SIBO-focused clinicians may include:

The Root Causes article covers the workup in more detail.

10. What the Research Shows

Two studies are usually cited, and they answer different questions. The relapse figures come from an Italian cohort: of 80 patients whose glucose breath test normalized after one week of rifaximin (1,200 mg a day), 12.6% were positive again at 3 months, 27.5% at 6 months and 43.7% at 9 months. No prokinetic was studied (Lauritano 2008).

The prokinetic figures come from a retrospective chart review by Pimentel's group at Cedars-Sinai of 64 people with IBS and presumed SIBO whose symptoms and breath tests had resolved after antibiotics (Pimentel 2009). The 6 who received no preventive drug had symptoms return after an average of about 60 days. The 42 on erythromycin 50 mg at bedtime stayed symptom-free for about 139 days, a difference from no prevention that was not statistically significant (P=0.08). The 16 on tegaserod 2-6 mg at bedtime stayed symptom-free for about 242 days (P=0.003 against no prevention; P=0.004 against erythromycin), and 20 patients switched from erythromycin to tegaserod went from about 106 to about 200 symptom-free days.

These results support a possible role for prokinetics but are limited: the study was not randomized, the comparison group had six people, it measured the return of symptoms rather than repeat breath tests, and its best-performing drug, tegaserod, is now listed as discontinued in the US. Neither study reports a relapse rate for patients on erythromycin.

Randomized trials of prokinetics for preventing SIBO relapse, and head-to-head comparisons between them, are lacking. Choices among erythromycin, prucalopride, LDN and herbal products are described as resting on cost, access, tolerance, IBS subtype (constipation vs. diarrhea) and individual response; decisions about these medicines and supplements belong with a clinician.

Key Research Papers

Peer-reviewed literature on the migrating motor complex, prokinetic pharmacology, and SIBO relapse prevention. Each citation links to its DOI or PubMed record.

  1. Pimentel M, Saad RJ, Long MD, Rao SSC. ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth. American Journal of Gastroenterology. 2020;115(2):165–178. — doi:10.14309/ajg.0000000000000501
  2. Pimentel M, Soffer EE, Chow EJ, Kong Y, Lin HC. Lower Frequency of MMC Is Found in IBS Subjects with Abnormal Lactulose Breath Test, Suggesting Bacterial Overgrowth. Digestive Diseases and Sciences. 2002;47(12):2639–2643. — doi:10.1023/A:1021039032413
  3. Pimentel M, Morales W, Pokkunuri V, et al. Autoimmunity Links Vinculin to the Pathophysiology of Chronic Functional Bowel Changes Following Campylobacter jejuni Infection in a Rat Model. Digestive Diseases and Sciences. 2015;60(5):1195–1205. — doi:10.1007/s10620-014-3435-5
  4. Pimentel M, Lin HC, Enayati P, et al. Methane, a Gas Produced by Enteric Bacteria, Slows Intestinal Transit and Augments Small Intestinal Contractile Activity. American Journal of Physiology — Gastrointestinal and Liver Physiology. 2006;290(6):G1089–G1095. — doi:10.1152/ajpgi.00574.2004
  5. Pimentel M, Morales W, Lezcano S, Sun-Chuan D, Low K, Yang J. Low-Dose Nocturnal Tegaserod or Erythromycin Delays Symptom Recurrence after Treatment of Irritable Bowel Syndrome Based on Presumed Bacterial Overgrowth. Gastroenterology & Hepatology (N Y). 2009;5(6):435–442. — PubMed PMID: 20574504
  6. Tack J, van Outryve M, Beyens G, Kerstens R, Vandeplassche L. Prucalopride (Resolor) in the Treatment of Severe Chronic Constipation in Patients Dissatisfied with Laxatives. Gut. 2009;58(3):357–365. — doi:10.1136/gut.2008.162404
  7. Camilleri M, Beyens G, Kerstens R, Robinson P, Vandeplassche L. Safety Assessment of Prucalopride in Elderly Patients with Constipation: A Double-Blind, Placebo-Controlled Study. Neurogastroenterology & Motility. 2009;21(12):1256–e117. — doi:10.1111/j.1365-2982.2009.01398.x
  8. Lauritano EC, Gabrielli M, Scarpellini E, et al. Small Intestinal Bacterial Overgrowth Recurrence after Antibiotic Therapy. American Journal of Gastroenterology. 2008;103(8):2031–2035. — doi:10.1111/j.1572-0241.2008.02030.x
  9. Chedid V, Dhalla S, Clarke JO, et al. Herbal Therapy Is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth. Global Advances in Health and Medicine. 2014;3(3):16–24. — doi:10.7453/gahmj.2014.019
  10. Pittman N, Rawn SM, Wang M, Masetto A, Beattie KA, Larché M. Treatment of Small Intestinal Bacterial Overgrowth in Systemic Sclerosis: A Systematic Review. Rheumatology. 2018;57(10):1802–1811. — doi:10.1093/rheumatology/key175
  11. Madisch A, Holtmann G, Plein K, Hotz J. Treatment of Irritable Bowel Syndrome with Herbal Preparations: Results of a Double-Blind, Randomized, Placebo-Controlled, Multi-Centre Trial. Alimentary Pharmacology & Therapeutics. 2004;19(3):271–279. — doi:10.1111/j.1365-2036.2004.01859.x
  12. Deloose E, Janssen P, Depoortere I, Tack J. The migrating motor complex: control mechanisms and its role in health and disease. Nature Reviews Gastroenterology & Hepatology. 2012;9(5):271–285. — PubMed PMID: 22450306
  13. Mondal A, Koyama K, Mikami T, et al. Underlying mechanism of the cyclic migrating motor complex in Suncus murinus: a change in gastrointestinal pH is the key regulator. Physiological Reports. 2017;5(1):e13105. — PubMed PMID: 28082431
  14. Deloose E, Tack J. Redefining the functional roles of the gastrointestinal migrating motor complex and motilin in small bacterial overgrowth and hunger signaling. American Journal of Physiology — Gastrointestinal and Liver Physiology. 2016;310(4):G228–G233. — PubMed PMID: 26660537
  15. Lauritano EC, Bilotta AL, Gabrielli M, et al. Association between hypothyroidism and small intestinal bacterial overgrowth. Journal of Clinical Endocrinology and Metabolism. 2007;92(11):4180–4184. — PubMed PMID: 17698907
  16. Lewis TD. Morphine and gastroduodenal motility. Digestive Diseases and Sciences. 1999;44(11):2178–2186. — PubMed PMID: 10573360
  17. Takahashi T. Interdigestive migrating motor complex -its mechanism and clinical importance. Journal of Smooth Muscle Research. 2013;49:99–111. — PubMed PMID: 24662475
  18. Pimentel M, Morales W, Rezaie A, et al. Development and validation of a biomarker for diarrhea-predominant irritable bowel syndrome in human subjects. PLoS One. 2015;10(5):e0126438. — PubMed PMID: 25970536
  19. Dervin H, Zarate-Lopez N, Sweis R, et al. Low prevalence of positive hydrogen breath tests in patients with functional gastrointestinal conditions and hypermobile Ehlers-Danlos syndrome. Neurogastroenterology & Motility. 2023;35(9):e14570. — PubMed PMID: 36989174
  20. Sweerts KWE, Mujagic Z, Keszthelyi D, Conchillo JM. Analysis of Antroduodenal Motility in Patients With Hypermobility Spectrum Disorders/Hypermobile Ehlers-Danlos Syndrome. Alimentary Pharmacology & Therapeutics. 2025;61(4):702–705. — PubMed PMID: 39745483
  21. Gabrielli M, Bonazzi P, Scarpellini E, et al. Prevalence of small intestinal bacterial overgrowth in Parkinson's disease. Movement Disorders. 2011;26(5):889–892. — PubMed PMID: 21520278
  22. Parlesak A, Klein B, Schecher K, Bode JC, Bode C. Prevalence of small bowel bacterial overgrowth and its association with nutrition intake in nonhospitalized older adults. Journal of the American Geriatrics Society. 2003;51(6):768–773. — PubMed PMID: 12757562
  23. Husebye E, Engedal K. The patterns of motility are maintained in the human small intestine throughout the process of aging. Scandinavian Journal of Gastroenterology. 1992;27(5):397–404. — PubMed PMID: 1529275
  24. Schönfeld J, Evans DF, Wingate DL. Daytime and night time motor activity of the small bowel after solid meals of different caloric value in humans. Gut. 1997;40(5):614–618. — PubMed PMID: 9203939
  25. Soffer EE, Adrian TE. Effect of meal composition and sham feeding on duodenojejunal motility in humans. Digestive Diseases and Sciences. 1992;37(7):1009–1014. — PubMed PMID: 1618049
  26. Scott SM, Knowles CH, Wang D, et al. The nocturnal jejunal migrating motor complex: defining normal ranges by study of 51 healthy adult volunteers and meta-analysis. Neurogastroenterology & Motility. 2006;18(10):927–935. — PubMed PMID: 16961696
  27. Björnsson ES, Abrahamsson H. Comparison between physiologic and erythromycin-induced interdigestive motility. Scandinavian Journal of Gastroenterology. 1995;30(2):139–145. — PubMed PMID: 7732336
  28. Dhir R, Richter JE. Erythromycin in the short- and long-term control of dyspepsia symptoms in patients with gastroparesis. Journal of Clinical Gastroenterology. 2004;38(3):237–242. — PubMed PMID: 15128069
  29. Richards RD, Davenport K, McCallum RW. The treatment of idiopathic and diabetic gastroparesis with acute intravenous and chronic oral erythromycin. American Journal of Gastroenterology. 1993;88(2):203–207. — PubMed PMID: 8424421
  30. Ray WA, Murray KT, Meredith S, Narasimhulu SS, Hall K, Stein CM. Oral erythromycin and the risk of sudden death from cardiac causes. New England Journal of Medicine. 2004;351(11):1089–1096. — PubMed PMID: 15356306
  31. Bouras EP, Camilleri M, Burton DD, Thomforde G, McKinzie S, Zinsmeister AR. Prucalopride accelerates gastrointestinal and colonic transit in patients with constipation without a rectal evacuation disorder. Gastroenterology. 2001;120(2):354–360. — PubMed PMID: 11159875
  32. Keller GA, Di Girolamo G. Prokinetic agents and QT prolongation: a familiar scene with new actors. Current Drug Safety. 2010;5(1):73–78. — PubMed PMID: 20210722
  33. Sayuk GS, Tack J. Tegaserod: What's Old Is New Again. Clinical Gastroenterology and Hepatology. 2022;20(10):2175–2184.e19. — PubMed PMID: 35123085
  34. Kariv R, Tiomny E, Grenshpon R, et al. Low-dose naltreoxone for the treatment of irritable bowel syndrome: a pilot study. Digestive Diseases and Sciences. 2006;51(12):2128–2133. — PubMed PMID: 17080248
  35. Ploesser J, Weinstock LB, Thomas E. Low dose naltrexone: side effects and efficacy in gastrointestinal disorders. International Journal of Pharmaceutical Compounding. 2010;14(2):171–173. — PubMed PMID: 23965429
  36. Younger J, Mackey S. Fibromyalgia symptoms are reduced by low-dose naltrexone: a pilot study. Pain Medicine. 2009;10(4):663–672. — PubMed PMID: 19453963
  37. Rao AS, Camilleri M. Review article: metoclopramide and tardive dyskinesia. Alimentary Pharmacology & Therapeutics. 2010;31(1):11–19. — PubMed PMID: 19886950
  38. Melzer J, Rösch W, Reichling J, Brignoli R, Saller R. Meta-analysis: phytotherapy of functional dyspepsia with the herbal drug preparation STW 5 (Iberogast). Alimentary Pharmacology & Therapeutics. 2004;20(11-12):1279–1287. — PubMed PMID: 15606389
  39. Pilichiewicz AN, Horowitz M, Russo A, et al. Effects of Iberogast on proximal gastric volume, antropyloroduodenal motility and gastric emptying in healthy men. American Journal of Gastroenterology. 2007;102(6):1276–1283. — PubMed PMID: 17378904
  40. Teschke R, Frenzel C, Glass X, Schulze J, Eickhoff A. Greater Celandine hepatotoxicity: a clinical review. Annals of Hepatology. 2012;11(6):838–848. — PubMed PMID: 23109446
  41. Wu KL, Rayner CK, Chuah SK, et al. Effects of ginger on gastric emptying and motility in healthy humans. European Journal of Gastroenterology & Hepatology. 2008;20(5):436–440. — PubMed PMID: 18403946
  42. Hu ML, Rayner CK, Wu KL, et al. Effect of ginger on gastric motility and symptoms of functional dyspepsia. World Journal of Gastroenterology. 2011;17(1):105–110. — PubMed PMID: 21218090
  43. Pertz HH, Lehmann J, Roth-Ehrang R, Elz S. Effects of ginger constituents on the gastrointestinal tract: role of cholinergic M3 and serotonergic 5-HT3 and 5-HT4 receptors. Planta Medica. 2011;77(10):973–978. — PubMed PMID: 21305447
  44. Yuan J, Shen XZ, Zhu XS. [Effect of berberine on transit time of human small intestine]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 1994;14(12):718–720. [Article in Chinese.] — PubMed PMID: 7719104
  45. Yin J, Xing H, Ye J. Efficacy of berberine in patients with type 2 diabetes mellitus. Metabolism. 2008;57(5):712–717. — PubMed PMID: 18442638
  46. Peterson CT, Pourang A, Dhaliwal S, et al. Modulatory Effects of Triphala and Manjistha Dietary Supplementation on Human Gut Microbiota: A Double-Blind, Randomized, Placebo-Controlled Pilot Study. Journal of Alternative and Complementary Medicine. 2020;26(11):1015–1024. — PubMed PMID: 32955913
  47. Giacosa A, Guido D, Grassi M, et al. The Effect of Ginger (Zingiber officinalis) and Artichoke (Cynara cardunculus) Extract Supplementation on Functional Dyspepsia: A Randomised, Double-Blind, and Placebo-Controlled Clinical Trial. Evidence-Based Complementary and Alternative Medicine. 2015;2015:915087. — PubMed PMID: 25954317
  48. Lazzini S, Polinelli W, Riva A, Morazzoni P, Bombardelli E. The effect of ginger (Zingiber officinalis) and artichoke (Cynara cardunculus) extract supplementation on gastric motility: a pilot randomized study in healthy volunteers. European Review for Medical and Pharmacological Sciences. 2016;20(1):146–149. — PubMed PMID: 26813467
  49. Franke A, Harder H, Orth AK, Zitzmann S, Singer MV. Postprandial walking but not consumption of alcoholic digestifs or espresso accelerates gastric emptying in healthy volunteers. Journal of Gastrointestinal and Liver Diseases. 2008;17(1):27–31. — PubMed PMID: 18392240
  50. Sanaka M, Urita Y, Yamamoto T, et al. Right recumbent position on gastric emptying of water evidenced by (13)C breath testing. World Journal of Gastroenterology. 2013;19(3):362–365. — PubMed PMID: 23372358
  51. Anvari M, Horowitz M, Fraser R, et al. Effects of posture on gastric emptying of nonnutrient liquids and antropyloroduodenal motility. American Journal of Physiology. 1995;268(5 Pt 1):G868–G871. — PubMed PMID: 7762670
  52. Lo WK, Chan WW. Proton pump inhibitor use and the risk of small intestinal bacterial overgrowth: a meta-analysis. Clinical Gastroenterology and Hepatology. 2013;11(5):483–490. — PubMed PMID: 23270866

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