Quick Answer
Prokinetics stimulate the migrating motor complex (MMC) — the cleaning wave that sweeps bacteria out of the small intestine. Without prokinetics after SIBO treatment, relapse is common.
Why Relapse Happens
SIBO treatment kills bacteria but doesn't fix the motility problem that allowed overgrowth in the first place. Without addressing motility, bacteria repopulate the small intestine.
Prokinetics: Where They Fit
Prokinetics should be used:
- During treatment: Support MMC function
- After treatment: Prevent repopulation (3-6 months minimum)
- Ongoing: For those with chronic motility issues
Practical Relapse-Prevention Stack (12 Weeks)
Phase 1 (Weeks 1-4): Lock Stability
- Prescription prokinetic or ginger/artichoke extract
- Before bed dosing (supports overnight MMC)
- 4-5 hour meal spacing
- No snacking
Phase 2 (Weeks 5-8): Begin Diet Expansion
- Continue prokinetic
- Gradually reintroduce foods
- Monitor for symptom drift
Phase 3 (Weeks 9-12): Assess & Adjust
- Evaluate symptom stability
- Consider prokinetic taper if stable
- Maintain meal spacing indefinitely
Prokinetic Options
- Prescription: Prucalopride, low-dose erythromycin
- Natural: Ginger (500mg), artichoke extract, prokinetic formulas
Key Takeaways
- Prokinetics are essential for SIBO relapse prevention
- Use for minimum 3-6 months post-treatment
- Combine with meal spacing (4-5 hours)
- Work with a clinician on proper dosing
Educational only, not medical advice. Work with a qualified clinician.