Significance: The current literature regarding the effects of the gaseous signal molecule hydrogen sulfide (H 2 S) in the gastrointestinal system is reviewed. Bacterial, host and pharmaceutical-derived H 2 S are all considered and presented according to the physiological or pathophysiological effects of the gaseous signal molecule. These subjects include the toxicology of intestinal H 2 S with emphasis on bacterial-derived H 2 S, especially from sulfatereducing bacteria, the role of endogenous and exogenous H 2 S in intestinal inflammation, and the roles of H 2 S in gastrointestinal motility, secretion and nociception. Recent Advances: While its pro-and anti-inflammatory, smooth muscle relaxant, prosecretory, and pro-and antinociceptive actions continue to remain the major effects of H 2 S in this system; recent findings have expanded the potential molecular targets for H 2 S in the gastrointestinal tract. Critical Issues: Numerous discrepancies remain in the literature, and definitive molecular targets in this system have not been supported by the use of competitive antagonism. Future Directions: Future work will hopefully resolve discrepancies in the literature and identify molecular targets and mechanisms of action for H 2 S. It is clear from the current literature that the long-appreciated relationship between H 2 S and the gastrointestinal tract continues to be strong as we endeavor to unravel its mysteries. Antioxid. Redox Signal. 20, 818-830.