• The gut microbiota and intestinal motility form a bidirectional homeostatic system, with dysbiosis and impaired motility creating a self-reinforcing vicious cycle.
• Four regulatory axes (metabolic, neuronal, immunological, mechanical) mediate microbiota-driven motility, with key pathways including butyrate-5-HT, tryptophan-AhR, and microbiota-ammonia-ACh.
• Four self-reinforcing pathological sub-loops (butyrate-hypoxia, Piezo2-Fusobacterium, ENS damage, brain-gut axis) drive disease progression and explain resistance to spontaneous recovery.
• Multi-node combination interventions targeting pathogen clearance, butyrate restoration, metabolic compensation, and circadian alignment offer promising therapeutic strategies.