Giving a pro-kinetic to adults taking proton pump inhibitors reduced risk of getting small intestinal bacterial overgrowth (SIBO) from 13% to 1% in this recent study,
Researchers prescribed levosulpiride ; a pro-kinetic that acts on dopamine D2 receptors centrally and peripherally to be given in tandem with the PPI.
That's pretty significant given the risk of SIBO goes up with PPI only therapy.
In the U.S , we are desperately lacking in good prescriptive pro-kinetics. Another one that is often spoken about in this setting is Domperidone ; which is a D2 antagonist as well. I don't believe we have on-label approval for any of these medications in the U.S.
This study hints that so much of SIBO is pointed toward motility disruption.
My favorite pro-kinetic that is Naturopathic is likely Iberogast which contains prokinetic herbs ;Iberis amara (bitter candytuft) fresh whole plant, Angelica archangelica (angelica root) dried root, Matricaria recutita (chamomile) dried flower head, Carum carvi (caraway) dried fruit, Silybum marianum (milk thistle) dried fruit, and .Melissa officinalis (balm leaf) dried leaf .
I also like a supplement called Prokine by Vita Aid which contains 5-HTP, Ginger and other neurotrophic agents (B12, Bentofamine,etc) that helps stimulate intestinal motility.
Because they help promote cleansing waves of the intestine by activating the migrating motor complex; which is your body's natural way of reducing bacterial overgrowth in the stomach and small intestine.
I also believe strongly in the importance of spacing meals 3-5 hours apart to help promote cleansing waves. Grazing blocks cleansing waves. Learn more here /