Consenso colombiano de Falla Intestinal Crónica en Síndrome de Intestino Corto / Colombian Consensus on Chronic Intestinal Failure in Short Bowel Syndrome

Introducción. Los términos falla intestinal crónica, síndrome de intestino corto (SIC) y nutrición parenteral total son muy frecuentes en la práctica clínica cotidiana.El objetivo de esta guía fue establecer un marco de referencia de práctica clínica basado en el mejor de nivel de evidencia en pacientes con falla intestinal crónica secundaria a síndrome de intestino corto. Métodos. Se estableció un grupo de expertos interdisciplinarios en el manejo de la falla intestinal crónica quienes, previa revisión de la literatura escogida, se reunieron de manera virtual acogiendo el método Delphi para discutir una serie de preguntas seleccionadas, enfocadas en el contexto terapéutico de la falla intestinal crónica asociada al síndrome de intestino corto. Resultados. La recomendación del grupo de expertos colombianos es que se aconseje a los pacientes con SIC consumir dietas regulares de alimentos integrales que genere hiperfagia para compensar la malabsorción. Las necesidades proteicas y energéticas dependen de las características individuales de cada paciente; la adecuación del régimen debe ser evaluada a través de pruebas clínicas, antropométricas y parámetros bioquímicos. Se sugiere, especialmente a corto plazo después de la resección intestinal, el uso de análogos de somatostatina para pacientes con yeyunostomía de alto gasto en quienes el manejo de líquidos y electrolitos es problemático. En pacientes con SIC, que son candidatos a tratamiento con enterohormonas, Teduglutida es la primera opción. Conclusión. Existen recomendaciones en el manejo integral de la rehabilitación intestinal respaldadas ampliamente por este consenso y es importante el reconocimiento de alternativas terapéuticos enmarcadas en el principio de buenas prácticas clínicas.

Introduction. The terms chronic intestinal failure, short bowel syndrome (SBS), and total parenteral nutrition are very common in daily clinical practice. The objective of this guideline was to establish a reference framework for clinical practice based on the best level of evidence in patients with chronic intestinal failure secondary to short bowel syndrome. Methods. A group of interdisciplinary experts in the management of chronic intestinal failure was established who, after reviewing the selected literature, met virtually using the Delphi method to discuss a series of selected questions, focused on the therapeutic context of chronic intestinal failure associated with short bowel syndrome. Results. The recommendation of the Colombian expert group is that patients with SBS be advised to consume regular diets of whole foods that generate hyperphagia to compensate malabsorption. Protein and energy needs depend on the individual characteristics of each patient; the adequacy of the regimen must be evaluated through clinical, anthropometric tests and biochemical parameters. The use of somatostatin analogue is suggested, especially in the short term after bowel resection, for patients with high-output jejunostomy in whom fluid and electrolyte management is problematic. In SBS, who are candidates for enterohormonal therapy, Teduglutide is the first choice. Conclusion. There are recommendations on the comprehensive management of intestinal rehabilitation that are widely supported by this consensus and it is important to recognize therapeutic alternatives framed in the principle of good clinical practice.

Study on the effects and mechanism of Guiling Gao on the activity state of rats with damp-heat syndrome / 国际中医中药杂志

Objective:To investigate the effects of Guiling Gao on body temperature, gastrointestinal motility, gastrointestinal hormones, Th1/Th2 cytokines and water metabolism in rats with damp-heat syndrome.Methods:Totally 60 SD rats were randomly divided into control group, model group, mosapride group, Guiling Gao low dose group (3.4 g/kg), medium dose group (6.8 g/kg) and high dose group (13.6 g/kg) according to random number table method, with 10 rats in each group. Except for the blank group, the other groups adopted the method of "environmental factors + fat and sweet diet + biological factors" to prepare the rat model of damp heat syndrome of febrile diseases. After modeling, they were administered by gavage for 7 days. During the experiment, the general state, body weight and body temperature were observed, the gastric residue rate of rats was calculated by weighing method, the intestinal propulsion rate of rats was calculated by charcoal propulsion method, and the levels of serum motilin (MTL), gastrin (GAS), somatostatin (SS), substance P (SP),IL-4 and interferon-γ (IFN-γ) were detected by ELISA, and the changes of aquaporin 3 (AQP3) mRNA transcription level were detected by real-time PCR.Results:Compared with the model group, the weight of rats in Guiling Gao high dose group increased after experiment of 22 days ( P<0.05), and body temperature of rats in Guiling Gao medium and high dose group decreased in 19-20 day ( P<0.01); and the gastric emptying rate and the small intestine propulsion rate of small intestine in Guiling Gao medium and high dose group increased significantly ( P<0.01 or P<0.05); the serum MTL, GAS and SP levels increased ( P<0.01 or P<0.05), and SS decreased ( P<0.01 or P<0.05) in the Guiling Gao medium and high dose groups; The levels of IL-4, IFN-γ and IFN-γ/IL-4 ratio decreased ( P<0.01); The expression of AQP3 mRNA (1.16 ± 0.25 vs. 0.23 ± 0.01) in the Guiling Gao high dose group was up-regulated ( P<0.01). Conclusions:Guiling Gao can effectively improve the activity state of damp-heat syndrome model rats caused by complex factors. This mechanism may be related to enhancing gastrointestinal movement, increasing gastrointestinal hormone secretion, restoring the dynamic balance of immune system Th1/Th2 and promoting the transport of water from intestinal cavity.

Effect of chewing behavior modification on food intake, appetite and satiety-related hormones: A Systematic Review

Purpose: Obesity has become a growing public health issue worldwide. Studies have shown that eating rate is one of the most important factors to consider in the strategies to prevent and/or treat obesity. Eating rate can be reduced through different strategies, such as an increase in oro-sensory exposure, the modification of food texture, and an increase in the number of chewing cycles. The aim of this systematic review was to analyze the available evidence regarding the effect of chewing behavior modification on the parameters that contribute to obesity. Methods: A systematic search was done on the electronic databases Pubmed, Cochrane Central Register of Controlled Trials, and Scopus, using the terms "mastication", "chewing", "chewing speed", "prolonged chewing", "number of chews", "masticatory cycles" "satiety" "satiety response" "appetite", "appetite regulation", "nutritional status" and "obesity". Results: A total of 23 intervention studies were selected that intervened in the participants' chewing behavior, either by reducing the eating rate, increasing oro-sensory exposure, food hardness or the number of chewing cycles. In most studies these interventions were effective at reducing food intake, subjective appetite and improving the plasma levels of satiety-related hormones and metabolites; moreover, they reduced body mass index in the long term. Conclusion: The currently available evidence seems to indicate that modifications to chewing behavior can bring with it a myriad of benefits for the treatment of obesity.

Propósito: La obesidad se ha convertido en un problema de salud pública creciente a nivel mundial. Investigaciones han demostrado que la tasa de ingesta es uno de los factores importantes a considerar en las estrategias para prevenir o tratar la obesidad. La tasa de ingesta puede reducirse a través de diferentes estrategias; el aumento de la exposición oro-sensorial, la modificación de la textura de los alimentos y el aumento en el número de ciclos masticatorios. El objetivo de esta revisión sistemática fue analizar la evidencia disponible sobre el efecto de la modificación de la conducta masticatoria sobre los parámetros que contribuyen a la obesidad. Métodos: Se realizó una búsqueda sistemática en las bases de datos electrónicas Pubmed, Cochrane Central Register of Controlled Trials y Scopus, con los términos "mastication", "chewing", "chewing speed", "prolonged chewing", "number of chews", "masticatory cycles" "satiety" "satiety response" "appetite", "appetite regulation", "nutritional status" y "obesity". Resultados: Se seleccionaron 23 estudios que intervenían en el comportamiento masticatorio de los participantes, ya sea reduciendo de la tasa de ingesta, aumentando la exposición oro-sensorial, dureza de los alimentos y número de ciclos masticatorios. Estas intervenciones resultaron ser efectivas para reducir la ingesta de alimentos, el apetito subjetivo y mejorar los niveles plasmáticos de las hormonas y metabolitos relacionados con la saciedad, además, a largo plazo, permitieron reducciones en el índice de masa corporal. Conclusión: La evidencia disponible actualmente parece señalar que las modificaciones en el comportamiento masticatorio pueden traer consigo múltiples beneficios para el tratamiento de la obesidad.

Efficacy of mosapride versus domperidone in the treatment of functional dyspepsia and its effects on gastric motility indexes and gastrointestinal hormone levels / 中国基层医药

Objective:To investigate the efficacy of mosapride versus domperidone in the treatment of functional dyspepsia and its effects on gastric motility indexes and gastrointestinal hormone levels. Methods:Ninety-four patients with functional dyspepsia who received treatment in Huzhou Linghu People's Hospital between May 2019 and May 2021 were included in this study. They were randomly assigned to undergo treatment with either domperidone (control group, n = 47) or mosapride (study group, n = 47). Efficacy was compared between the two groups. Results:Total response rate in the study group was significantly higher than that in the control group ( χ2 = 5.04, P = 0.025). After medication, motilin, plasma leptin and corticotropin-releasing hormone in the study group were (184.22 ± 25.36) μg/mL, (18.57 ± 2.44) μg/L, (7.21 ± 1.14) pg/mL, respectively, which were superior to those in the control group [(111.25 ± 21.00) μg/mL, (15.41 ± 2.28) μg/L, (9.02 ± 1.32) μg/mL, t = 15.19, 6.48, 16.23, P < 0.001, < 0.001, < 0.001]. After medication, cholecystokinin, somatostatin, vasoactive intestinal peptide and gastrin levels in the study group were (45.36 ± 5.12) ng/L, (5.48 ± 1.25) ng/L, (86.35 ± 12.11) pg/mL, and (105.24 ± 12.05) ng/L, respectively, which were significantly superior to those in the control group [(50.21 ± 6.18) ng/L, (7.01 ± 0.98) ng/L, (98.75 ± 14.18) pg/mL and (97.35 ± 11.48) ng/L, t = 4.14, 6.60, 4.55, 3.25, P < 0.001, < 0.001, < 0.001, < 0.002]. The recurrence rate in the study group was significantly lower than that in the control group (2.13% vs. 27.66%, χ2 = 4.66, P = 0.031). The incidence of adverse reactions in the study group was significantly lower than that in the control group (14.89% vs. 34.04%, χ2 = 10.80; P = 0.001). Conclusion:Mosapride has a better therapeutic effect on functional dyspepsia, exhibits a greater effect on improving gastric motility indexes and gastrointestinal hormone levels, and leads to a lower incidence of recurred functional dyspepsia than domperidone. Therefore, mosapride for treatment of functional dyspepsia deserves clinical promotion.

Ultrasound-guided stellate ganglion block accelerates postoperative gastrointestinal function recovery following laparoscopic radical gastrectomy for gastric cancer / 南方医科大学学报

OBJECTIVE@#To explore the effects of ultrasound-guided stellate ganglion block (SGB) on perioperative stress response, gastrointestinal hormones and postoperative gastrointestinal function recovery in patients undergoing laparoscopic radical gastrectomy for gastric cancer.@*METHODS@#This study was conducted among 60 American Society of Anesthesiologists (ASA) class II-III patients with gastric cancer (regardless of gender, aged 35-75 years with BMI of 18.5-26 kg/m2) undergoing elective laparoscopic radical gastrectomy. The patients were randomized into experimental group (S group, n=30) and control group (NS group, n=30). In S group, SGB at the C6 level of the right cervical spine was performed under ultrasound guidance 15 min before induction of anesthesia by injection of 7 mL 0.5% ropivacaine; the patients in NS group received injections of normal saline in the same manner. Peripheral venous blood samples were collected before SGB (T1), after surgery (T2), and on the 2nd and 6th days after surgery (T3 and T4) for determination of the levels of motitin (MOT), vasoactive intestinal peptide (VIP), cortisol (COR), and blood glucose (GLU). Intraoperative usage of sufentanil, recovery rate of intestinal sounds at 36, 48, 60, 72, 84 and 96 h after operation and the time of first passage of flatus were recorded and compared between the two groups.@*RESULTS@#There was no significant difference in the total amount of sufentanil consumption between the two groups. Compared with those in NS group, the patients in S group had significant lower COR and VIP levels (P < 0.05) and higher MOT level (P < 0.05) at T2, T3 and T4. Glu level at T2 and T3 was also significantly lower in S group (P < 0.05). The recovery rates of intestinal sounds at 36, 48, 60, 72 and 84 h after surgery were significantly higher (P < 0.05) and the time of the first passage of flatus was earlier in S group than in NS group (P < 0.05).@*CONCLUSION@#In patients with gastric cancer undergoing laparoscopic radical gastrectomy, ultrasound-guided SGB can reduce postoperative stress level, promote the recovery of gastrointestinal hormone secretion, and accelerate postoperative recovery of gastrointestinal functions.

Clinical Study on Dialectical Treatment of Modified Xiangsha Liu Junzitang to Diabetes Gastroparesis with Weakness Syndrome of Spleen and Stomach / 中国实验方剂学杂志

Objective:This study aims to investigate the clinical efficacy of Modified Xiangsha Liu Junzitang in the treatment of diabetic gastroparesis （DGP） and its influence on gastrointestinal hormones and oxidative stress. Method:In this study， 128 patients were randomly divided into control group （64 cases） and observation group （64 cases） . Patients in two groups took domperidone tablets orally 30 minutes before meals， 10 mg/time， 3 times/day. Patients in control group took Shenling Baizhusan San， 6 g/time， twice a day. Patients in observation group were prescribed addition and subtraction therapy of Modified Xiangsha Liu Junzitang， 1 dose/day. The course of treatment for both groups was 4 weeks. Before and after treatment， scores of gastroparesis cardinal symptom index （GCSI）， and gastric emptying test and electrogastrogram were noted. Before the treatment， scores of traditional Chinese medicine （TCM） syndrome and health survey summary were graded（SF-36）. The levels of gastrin （GAS）， motilin （MTL）， vasoactive intestinal peptide （VIP）， somatostatin （SS）， superoxide dismutase （SOD）， reactive oxygen species （ROS） and malondialdehyde （MDA） were measured before and after treatment. And adverse reactions during treatment were recorded. Result:The scores of postprandial abdominal distension/early satiety， nausea and vomiting， abdominal distention and the total scores of GCSI in the observation group were lower than those in control group （<italic>P</italic><0.01）. The gastric emptying rate in observation group was higher than that in control group （<italic>P</italic><0.01）， and the score of TCM syndromes was lower than that of control group （<italic>P</italic><0.01）. The scores of SF-36 in observation group were higher than those in control group （<italic>P</italic><0.01）. The frequency of gastric electricity and gastric electric vibration before and after the meal in observation group were higher than that in control group （<italic>P</italic><0.01）. The levels of GAS， MTL， VIP， ROS and MDA in observation group were lower than those in control group （<italic>P</italic><0.01）， while the levels of SS and SOD were higher than that of control group （<italic>P</italic><0.01）. The total effective rate in observation group was 93.75% （60/64）， which was higher than 79.69% （51/64） （<italic>χ</italic>²=5.494， <italic>P</italic><0.05） in control group （<italic>P</italic><0.01）. And no adverse reactions were found in the clinical observation. Conclusion:Modified Xiangsha Liu Junzitang combined with prokinetic drugs in the treatment of DGP patients can reduce the clinical symptoms of DGP， enhance gastrointestinal motility， improve the gastric emptying rate， improve the quality of life， regulate the level of gastrointestinal hormones， and reduce the damage of autonomic nerve caused by oxidative stress， with good comprehensive clinical effect and safety in application.

Clinical Efficacy of Modified Heweitang in Treatment of Functional Dyspepsia Due to Liver-stomach Disharmony / 中国实验方剂学杂志

Objective:To explore the clinical efficacy and safety of modified Heweitang in the treatment of functional dyspepsia （FD） due to liver-stomach disharmony and its regulation of gastrointestinal hormones and brain-gut peptides. Method:One hundred and twenty-six eligible patients were randomized into a control group （62 cases） and an observation group （64 cases）. Patients in the observation group took the modified Heweitang granules with warm water 30 min after meals， 10 g/time， 3 times/day， while those in the control group took the corresponding placebo granules at the same dose in the same manner. The treatment in both groups lasted for four weeks. Before and after treatment， the four main symptoms including postprandial satiety， early satiety， upper abdominal pain， and upper abdominal burning sensation were scored， followed by the examination of gastric emptying （GE） and the scoring of the functional digestive disorders quality of life questionnaire （FDDQL）， 7-point global overall symptom scale （GOSS）， and liver-stomach disharmony syndrome. The cholecystokinin （CCK）， motilin （MTL）， gastrin （GAS）， serotonin （5-HT）， vasoactive intestinal peptide （VIP）， and substance P （SP） levels before and after treatment were detected， and then the safety was evaluated. Result:After treatment， the scores of the four main symptoms， GOSS， and liver-stomach disharmony syndrome in the observation group were lower than those in the control group （<italic>P</italic><0.01）， while the GE rate and FDDQL scores in the observation group were higher （<italic>P</italic><0.01）. The CCK， GAS， 5-HT， and VIP levels of the observation group declined as compared with those of the control group （<italic>P</italic><0.01）， whereas the MTL and SP levels were elevated （<italic>P</italic><0.01）. After treatment， the overall response rate in the observation group was （51/57）89.47%， higher than （15/56）26.79% in the control group （<italic>χ</italic>²=45.696， <italic>P</italic><0.01）. No drug-related adverse reactions were found during the trial. Conclusion:The modified Heweitang is efficient and safe in relieving the main and related symptoms and traditional Chinese medicine （TCM） syndrome， regulating the secretion of gastrointestinal hormones and brain-gut peptides， promoting GE rate， and improving the quality of life of patients with FD due to liver-stomach disharmony.

Clinical Observation on Addition and Subtraction Therapy of Huaganjian Combined with Jinlingzisan in Patients with Bile Reflux Gastritis with Stagnancy Heat of Liver and Stomach Syndrome / 中国实验方剂学杂志

Objective:To evaluate the efficacy of addition and subtraction therapy of Huaganjian combined with Jinlingzisan for bile reflux gastritis （BRG） with stagnancy heat of liver and stomach syndrome， and to investigate its effect on inflammatory factors and gastrointestinal hormones. Method:One hundred and fifty patients were divided into control group and observation group evenly according to random number table. The 68 patients in control group finished the treatment （5 cases of dropout， loss of follow-up and 2 cases of withdrawal）， and 69 patients in observation group completed the treatment （3 cases of dropout， loss of follow-up and 3 cases of withdrawal）. Patients in control group got oral Dalitong granules before the meal， 1 bag/time， 3 times/day. Patients in observation group got addition and subtraction therapy of Huaganjian combined with Jinlingzisan， 1 dose/day. The treatment continued for 4 weeks in both groups. Before the treatment， gastroscope was used to evaluate the degree of bile reflux and the condition of mucosa under gastroscope. Before and after treatment， scores of stagnancy heat of liver and stomach syndrome， patient reported outcome （PRO） scale of chronic gastrointestinal diseases， self rating anxiety scale （SAS）， and self rating depression scale （SDS） were recorded. A follow-up of 6 months was conducted to record the clinical recurrence. Levels of gastrin （GAS）， motilin （MTL）， cholecystokinin （CCK）， prostaglandin E2 （PGE2）， tumor necrosis factor-α （TNF-α）， and interleukin-8 （IL-8） were detected both before and after treatment. In addition， the safety was discussed. Result:Scores of degree of bile reflux， mucosa under gastroscope and stagnancy heat of liver and stomach syndrome in the observation group were lower than those in control group （<italic>P</italic><0.01）. Scores of 6 dimensions in PRO scale （dyspepsia， reflux， defecation， social， psychological， and general state） and scores of SAS and SDS in the observation group were lower than those in control group （<italic>P</italic><0.01）. Levels of CCK， TNF-α and IL-8 in the observation group were all lower than those detected in control group （P<0.01）， while levels of GAS and MTL were higher than those in control group （<italic>P</italic><0.01）. Observation group was superior to the control group in terms of efficacy for traditional Chinese medicine（TCM） syndrome and efficacy under gastroscope （<italic>Z</italic>=2.083， <italic>P</italic><0.05； <italic>Z</italic>=2.104， <italic>P</italic><0.05）. Clinical recurrence rate in observation group was 20.37% （11/54）， lower than 40.82% （20/49） in control group （<inline-formula><alternatives><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:msup><mml:mrow><mml:mi>χ</mml:mi></mml:mrow><mml:mrow><mml:mn mathvariant="normal">2</mml:mn></mml:mrow></mml:msup></mml:math><graphic specific-use="big" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="alternativeImage/CD75C203-D673-4226-A5C3-F3D84A74EF61-M002.jpg"><?fx-imagestate width="3.30199981" height="3.64066648"?></graphic><graphic specific-use="small" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="alternativeImage/CD75C203-D673-4226-A5C3-F3D84A74EF61-M002c.jpg"><?fx-imagestate width="3.30199981" height="3.64066648"?></graphic></alternatives></inline-formula>=5.105， <italic>P</italic><0.05）. No adverse reaction was found after oral administrationh of TCM. Conclusion:Addition and subtraction therapy of Huaganjian combined with Jinlingzisan can ameliorate the clinical symptoms， relieve anxiety and depression， improve the quality of life in patients with BRG and stagnancy heat of liver and stomach syndrome， improve the degree of bile reflux， promote the healing of gastric mucosa， reduce inflammatory reaction and regulate gastrointestinal hormones. It has good efficacy for TCM syndrome and under gastroscopy in a short term， and can reduce the recurrence rate with high safety in a long term.

Effect of Forsythionin A on Gastrointestinal Motility Disorders in Mice Treated with Chemotherapy / 中国实验方剂学杂志

Objective:To observe the effect of forsythiaside A on gastrointestinal motility disorder induced by chemotherapy in mice， and explore the mechanism of forsythiaside A regulating gastrointestinal motility. Method:The 60 KM mice were randomly divided into normal group， model group， metoclopramide group （5 mg·kg-1） and forsythiaside A low， medium and high-dose groups （30， 60， 120 mg·kg-1）， 10 for each group， which include half male and half female. The above dose was given once a day for 4 consecutive days， which the intragastric volume was 10 mL·kg-1. One hour after 1rd day administration， equal volume of saline was intraperitoneally injected to the normal group， 2 mg·kg-1 cisplatin was intraperitoneally injected to the other groups with daily for 4 consecutive days. Observing the effects of forsythiaside A on gastric emptying and small intestinal propulsion on mice models， serum gastrin （GAS） and somatostatin （SS）， motilin （MTL）， vasoactive intestinal peptide （VIP） levels were examined by enzyme-linked immunosorbent assay （ELISA）. Activities of acetylcholinesterase （AChE） and total nitric oxide synthase （tNOS） in gastric antrum and ileum were detected by ELISA. The expression of AChE and inducible nitric oxide synthase （iNOS） in gastric antrum and ileum were detected by Western blot. Result:Compared with normal group， the gastric retention rate and small intestinal propulsion rate of the model group were significantly increased （P<0.01）， serum levels of MTL， GAS， SS and VIP， the AChE activity in the homogenate of ileum in the model group were significantly reduced （P<0.05，P<0.01）， while the tNOS activities in gastric antrum and ileum were significantly increased （P<0.05，P<0.01）. Protein expression of AChE in gastric antrum and ileum were significantly decreased （P<0.05）， and the expression level of iNOS protein was significantly increased in the model group （P<0.05）. Compared with model group， different doses of forsythiaside A can reduce the gastric residual rate and small intestinal propulsion rate of mice to varying degrees. Meanwhile forsythiaside A can increase the serum levels of MTL， GAS， SS， and VIP， and the AChE activity and protein expression levels in gastric antrum and ileum tissues were also increased， while tNOS activity and iNOS protein expression were decreased in gastric antrum and ileum （P<0.05，P<0.01）. Conclusion:Forsythiaside A can significantly ameliorate the delayed gastric emptying and small intestine hyperfunction induced by cisplatin in mice. Its mechanism to ameliorate gastrointestinal dysfunction caused by chemotherapy is related to the regulation of gastrointestinal AChE and NOS activity in gastric antrum and ileum and the regulation of gastrointestinal hormone levels.

Expression levels of gastrointestinal hormones in the progression of liver fibrosis in patients with nonalcoholic fatty liver disease / 临床肝胆病杂志

Objective To investigate the changes in gastrointestinal hormones during the progression of liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD), and to provide a basis for digestive function impairment. Methods A prospective analysis was performed for 326 patients with NAFLD who attended the outpatient service and were hospitalized and treated in Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine from October 2018 to June 2020, and FibroTouch was used to measure liver stiffness measurement (LSM). According to the presence or absence of liver fibrosis, they were divided into non-liver fibrosis group (group A, 161 patients with LSM < 7.3 kPa) and liver fibrosis group (group B, 165 patients with LSM ≥7.3 kPa). According to the fibrosis degree, the patients were further divided into F0-1 group (LSM < 7.3 kPa), F2 group (7.3 kPa ≤LSM < 9.7 kPa), F2-3 group (9.7 kPa ≤LSM < 12.4 kPa), F3-4 group (12.4 kPa ≤LSM < 17.5 kPa), and F4 group (LSM ≥17.5 kPa). Related data were collected, including age, sex, liver function parameters, and gastrointestinal hormones. The independent samples t -test and the one-way analysis of variance were used for comparison of normally distributed continuous data between groups, and the nonparametric Mann-Whitney U test and the Kruskal-Wallis H test were used for comparison of non-normally distributed continuous data between groups. A Spearman correlation analysis was used to investigate the correlation between LSM and liver function parameters. Results Comparison of liver function and gastrointestinal hormones showed that there were significant differences between groups A and B in alanine aminotransferase (ALT) ( Z =-3.778, P < 0.001), aspartate aminotransferase (AST) ( Z =-3.320, P =0.001), gamma-glutamyl transpeptidase (GGT) ( Z =-3.040, P =0.002), cholecystokinin (CCK) ( t =-2.944, P =0.003), and lipopolysaccharide (LPS) ( Z =-2.317, P =0.020). There were significant differences in ALT ( χ 2 =23.113, P < 0.001), AST ( χ 2 =23.415, P < 0.001), ALP ( χ 2 =15.962, P =0.003), GGT ( χ 2 =20.172, P < 0.001), and CCK ( F =2.687, P =0.031) between the F0-1 group with 161 patients, the F2 group with 89 patients, the F2-3 group with 46 patients, the F3-4 group with 16 patients, and the F4 group with 14 patients. LSM was positively correlated with direct bilirubin, ALT, AST, alkaline phosphatase, and GGT ( r =0.128, 0.266, 0.225, 0.137, and 0.213, all P < 0.05). Conclusion Liver fibrosis progression in NAFLD can affect gallbladder contraction function and gastrointestinal function, and measurement of the serum levels of CCK and LPS has an important clinical value in the early diagnosis and treatment of digestive diseases related to gallbladder contraction function and gastrointe stinal function in NAFLD patients with liver fibrosis.

Expression levels of gastrointestinal hormones in the progression of liver fibrosis in patients with nonalcoholic fatty liver disease / 临床肝胆病杂志

Objective To investigate the changes in gastrointestinal hormones during the progression of liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD), and to provide a basis for digestive function impairment. Methods A prospective analysis was performed for 326 patients with NAFLD who attended the outpatient service and were hospitalized and treated in Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine from October 2018 to June 2020, and FibroTouch was used to measure liver stiffness measurement (LSM). According to the presence or absence of liver fibrosis, they were divided into non-liver fibrosis group (group A, 161 patients with LSM < 7.3 kPa) and liver fibrosis group (group B, 165 patients with LSM ≥7.3 kPa). According to the fibrosis degree, the patients were further divided into F0-1 group (LSM < 7.3 kPa), F2 group (7.3 kPa ≤LSM < 9.7 kPa), F2-3 group (9.7 kPa ≤LSM < 12.4 kPa), F3-4 group (12.4 kPa ≤LSM < 17.5 kPa), and F4 group (LSM ≥17.5 kPa). Related data were collected, including age, sex, liver function parameters, and gastrointestinal hormones. The independent samples t -test and the one-way analysis of variance were used for comparison of normally distributed continuous data between groups, and the nonparametric Mann-Whitney U test and the Kruskal-Wallis H test were used for comparison of non-normally distributed continuous data between groups. A Spearman correlation analysis was used to investigate the correlation between LSM and liver function parameters. Results Comparison of liver function and gastrointestinal hormones showed that there were significant differences between groups A and B in alanine aminotransferase (ALT) ( Z =-3.778, P < 0.001), aspartate aminotransferase (AST) ( Z =-3.320, P =0.001), gamma-glutamyl transpeptidase (GGT) ( Z =-3.040, P =0.002), cholecystokinin (CCK) ( t =-2.944, P =0.003), and lipopolysaccharide (LPS) ( Z =-2.317, P =0.020). There were significant differences in ALT ( χ 2 =23.113, P < 0.001), AST ( χ 2 =23.415, P < 0.001), ALP ( χ 2 =15.962, P =0.003), GGT ( χ 2 =20.172, P < 0.001), and CCK ( F =2.687, P =0.031) between the F0-1 group with 161 patients, the F2 group with 89 patients, the F2-3 group with 46 patients, the F3-4 group with 16 patients, and the F4 group with 14 patients. LSM was positively correlated with direct bilirubin, ALT, AST, alkaline phosphatase, and GGT ( r =0.128, 0.266, 0.225, 0.137, and 0.213, all P < 0.05). Conclusion Liver fibrosis progression in NAFLD can affect gallbladder contraction function and gastrointestinal function, and measurement of the serum levels of CCK and LPS has an important clinical value in the early diagnosis and treatment of digestive diseases related to gallbladder contraction function and gastrointe stinal function in NAFLD patients with liver fibrosis.

Clinical Efficacy of Modified Zhishi Daozhiwan on Slow Transit Constipation / 中国实验方剂学杂志

Objective::To observe the clinical efficacy of modified Zhishi Daozhiwan on slow transit constipation (STC) and the effect on gastrointestinal hormones and intestinal flora. Method::One hundred and sixty patients were randomly divided into control group and observation group by random number table. Patients in control group got Maren Wan, 1-2 pills/time, 2 times/days, and mosapride citrate tablets, 1 piece/time, 3 times/days. Patients in observation group got modified Zhishi Daozhiwan, 1 dose/day. A course of treatment was 4 weeks. Before and after treatment, the main symptoms of constipation and patient assessment of constipation symptoms (PAC-SYM) were scored. And times of spontaneous complete bowel movement (SCBM) and colonic transmission test were recorded. And levels of intestinal flora and motilin (MTL), vasoactive intestinal peptide (VIP), substance P (SP) and gastrin (GAS) were detected. The 12-week follow-up of patients (SCBM≥3) was recorded, and the relapse of disease was calculated. Result::According to rank sum test analysis, the clinical efficacy in observation group was better than that in control group (Z=2.275, P<0.05). After treatment, scores of the main symptoms of constipation, PAC-SYM, and the total score of PAC-SYM were all lower than those in control group (P<0.01). At the second, third and fourth weeks after treatment, the times of SCBM were more than those in control group (P<0.01). Ratio of residual marker at 24, 48 and 72 h was lower than that in control group (P<0.01). Count of enterococcus and enterobacter were lower than those in control group (P<0.01), while counts of bifidobacterium and lactobacillus were higher than in control group (P<0.01). Levels of GAS, MTL and SP were higher than those in control group, whereas level of VIP was lower than that in control group (P<0.01). And relapse rate in observation group was 33.85%, which was lower than 57.69% in control group (χ2=6.653, P<0.05). Conclusion::Modified Zhishi Daozhiwan can alleviate constipation and other symptoms, increase the number of SCBM, regulate gastrointestinal hormones and intestinal flora, and improve colonic transit function, with a good clinical efficacy and low recurrence rate, so it is worth clinical application.

Effects of intradermal needle therapy plus pinaverium bromide on gastrointestinal hormone levels in irritable bowel syndrome-diarrhea patients / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy difference in treating irritable bowel syndrome-diarrhea (IBS-D) of liver-qi stagnation and spleen-deficiency pattern with different treatment protocols, and the effects on serum levels of 5-hydroxytryptamine (5-HT), substance P (SP) and vasoactive intestinal peptide (VIP), for unveiling the mechanism of intradermal needle therapy plus pinaverium bromide in treating IBS-D. Methods: A total of 123 IBS-D patients were divided into an observation group, a Western medication group and an integrated Western and Chinese medication group using the random number table method, with 41 cases in each group. The Western medication group was given oral pinaverium bromide, 50 mg each time and 3 times a day. The integrated Western and Chinese medication group was given additional Chinese herbal medicine Tong Xie Yao Fang, one dose each day. The observation group was given additional intradermal needle therapy on the basis of the Western medication group. The whole intervention lasted for 6 weeks. Before and after treatment, the scores of gastrointestinal symptoms, traditional Chinese medicine (TCM) symptoms, irritable bowel syndrome (IBS) symptom severity scale (IBS-SSS) and IBS quality of life (IBS-QOL) questionnaire, as well as the serum levels of 5-HT, SP and VIP were observed. The clinical efficacy was estimated. Results: The total effective rate was 92.7％ in the observation group, 68.3％ in the Western medication group and 78.1％ in the integrated Western and Chinese medication group. The total effective rate was higher in the observation group than in the other two groups, and higher in the integrated Western and Chinese medication group than in the Western medication group, showing statistical significance (all P<0.05). After treatment, the scores of gastrointestinal symptoms, TCM symptoms and IBS-SSS showed significant decreases in the three groups, presenting statistical significance compared with the baseline (all P<0.05); the scores of gastrointestinal symptoms, TCM symptoms and IBS-SSS were notably lower in the observation group than in the other two groups (all P<0.05), and lower in the integrated Western and Chinese medication group than in the Western medication group (all P<0.05). After treatment, the eight component scores of IBS-QOL showed significant increases in the three groups compared with the baseline (all P<0.05); the eight component scores in IBS-QOL were significantly higher in the observation group than in the other two groups (all P<0.05), and higher in the integrated Western and Chinese medication group than in the Western medication group (all P<0.05). After treatment, the serum levels of 5-HT, SP and VIP decreased markedly in the three groups compared with the baseline (all P<0.05); the serum levels of 5-HT, SP and VIP were significantly lower in the observation group than in the other two groups (all P<0.05), and lower in the integrated Western and Chinese medication group than in the Western medication group (P<0.05). Conclusion: Treatment with intradermal needle therapy plus pinaverium bromide results in significant improvements in the gastrointestinal symptoms and quality of life in patients with IBS-D of liver-qi stagnation and spleen deficiency pattern, and effectively regulates the gastrointestinal hormone production.

Bipartição de trânsito intestinal isolada: uma nova estratégia para cirurgia em estágios em superobesos / Isolated intestinal transit bipartition: a new strategy for staged surgery in superobesity

RESUMO Objetivo: o duodenal switch é um procedimento disabsortivo complexo, associado aos melhores resultados de perda de peso e controle metabólico. A cirurgia em etapas, com gastrectomia vertical como primeiro passo, é uma opção para reduzir complicações em pacientes superobesos. No entanto, alguns problemas persistem, como fígados grandes, que dificultam a abordagem cirúrgica, e complicações, como fístulas graves. A bipartição do trânsito intestinal é um modelo modificado e simplificado de desvio biliopancreático que complementa a gastrectomia vertical. É semelhante ao duodenal switch com menores complexidade e consequências nutricionais. Este estudo avaliou a viabilidade e a segurança da bipartição de trânsito isolada como o procedimento inicial para tratar a superobesidade. Métodos: foram incluídos 41 pacientes superobesos, com IMC médio de 54,5±3,5kg/m2. Uma bipartição de trânsito isolada laparoscópica foi realizada como o primeiro procedimento em uma nova abordagem em duas etapas. Perda de peso e complicações foram analisadas durante um ano de acompanhamento. Resultados: todos os procedimentos foram completados por laparoscopia. Após seis meses, a perda média de excesso de peso percentual foi de 28%, permanecendo estável até o final do estudo. Não houve dificuldades intraoperatórias. Metade dos pacientes apresentou diarreia precoce e três tiveram úlceras marginais. Não houve complicações cirúrgicas maiores ou mortes. Conclusão: a bipartição de trânsito isolada laparoscópica é uma nova opção para uma abordagem em estágios na superobesidade, que pode permitir um segundo procedimento mais seguro após a perda de peso ao longo de seis meses. Pode ser útil, particularmente, para pacientes com obesidade grave.

ABSTRACT Objective: biliopancreatic diversion with duodenal switch is a complex, malabsorptive procedure, associated with improved weight loss and metabolic control. Staged surgery with sleeve gastrectomy as the first stage is an option for reducing complications in superobese patients. However, some problems persist: large livers can hamper the surgical approach and complications such as leaks can be severe. Intestinal transit bipartition is a modified and simplified model of biliopancreatic diversion that complements sleeve gastrectomy. It is similar to the duodenal switch, but with less complexity and fewer nutritional consequences. This study assessed the feasibility and safety of isolated transit bipartition as the initial procedure in a two-step surgery to treat superobesity. Methods: this prospective study included 41 superobese patients, with mean BMI 54.5±3.5kg/m2. We performed a laparoscopic isolated transit bipartition as the first procedure in a new staged approach. We analyzed weight loss and complications during one year of follow-up. Results: we completed all the procedures by laparoscopy. After six months, the mean percent excess weight loss was 28%, remaining stable until the end of the study. There were no intraoperative difficulties. Half of the patients experienced early diarrhea, and three had marginal ulcers. There were no major surgical complications or deaths. Conclusion: isolated laparoscopic transit bipartition is a new option for a staged approach in superobesity, which can provide a safer second procedure after effective weight loss over six months. It may be useful particularly in the management of patients with severe obesity.

Effect of Rhei Radix et Rhizoma on Gastrointestinal Function of Normal Rats Before and After Simmering / 中国实验方剂学杂志

Objective: To investigate the effect of Rhei Radix et Rhizoma on gastrointestinal function of normal rats and explore its therapeutic mechanism,and compare the difference of this herb before and after simmering. Method: Healthy SD rats were randomly divided into 7 groups,including the blank group,the high,medium and low dose groups of raw Rhei Radix et Rhizoma(1.5,3.0,6.0 g·kg-1·d-1) and the high,medium and low dose groups of simmered Rhei Radix et Rhizoma(1.5,3.0,6.0 g·kg-1·d-1),eight rats in each group were continuous intragastric administration for 10 days,the effect of Rhei Radix et Rhizoma on gastrointestinal function of rats were evaluated by body weight,food intake,gastric remnant rate,small intestine propelling rate,stomach weight coefficient and gastrointestinal tissue morphology;enzyme-linked immunosorbent assay(ELISA) was used to detect contents of motilin(MTL) in rat plasma and gastrin(GAS),tumor necrosis factor-α(TNF-α),interleukin-10(IL-10) in rat serum,the mechanism of effect of Rhei Radix et Rhizoma on gastrointestinal function was explored and the effect of Rhei Radix et Rhizoma on gastrointestinal function of normal rats before and after simmering was compared. Result: In each administration group,weight growth of rats was slowed down,gastric emptying and intestinal propulsion were inhibited,inflammatory reaction was triggered,and gastric mucosal injury was increased.Compared with the blank group, except for the low-dose and medium-dose groups of simmered Rhei Radix et Rhizoma,stomach weight coefficient,gastric remnant rate and content of TNF-α of rats were significantly increased(PPPPα of rats were all decreased to different degrees. Conclusion: Gastrointestinal dysfunction caused by Rhei Radix et Rhizoma is related to inhibiting the expression of gastrointestinal hormones and promoting the expression of inflammatory cytokines, in addition,the effect of "stomach injured by bitterness and cold property" of Rhei Radix et Rhizoma is weakened after simmering,which provides scientific basis for clinical rational use of Rhei Radix et Rhizoma.

Application of Precise Medication of Xiaoer Fupi Granules for Functional Dyspepsia Based Integrated Pharmacological Strategy / 中国实验方剂学杂志

Integrated pharmacological approach was used to predict the target genes and signal pathways of Xiaoer Fupi granules in the treatment of functional dyspepsia(FD), and the possible mechanism was discussed. The disease target information was collected by the DISEASES and UniProt databases, integrated pharmacological platform of traditional Chinese medicine(TCM-IP) was used to predict chemical composition, target, protein gene ontology(GO) function and Kyoto encyclopedia of genes and genomes(KEGG) pathway, and the networks of candidate target and TCMs-chemical components-core targets-key pathways were constructed. A total of 2 882 potential targets and 96 candidate target pathways were predicted, and β-1,4-galactosyltransferase(β-1,4-GalT) subtypes(B4GALT4, B4GALT2, B4GALT1) and phosphorylated protein kinase C subtype D(PRKCD), adenylate cyclase 2(ADCY2) and other targets were predicted. Some pathways were enriched, such as nervous system, endocrine system, thyroid hormone signaling pathway, long-term depression and other pathways related to FD. It was predicted that Xiaoer Fupi granules for treating FD by regulating gastrointestinal hormones, anti-depression, and regulating nerves and endocrine system. This study provides a basis for the precise clinical application and positioning of Xiaoer Fupi granules, and helps to clarify the mechanism of this drug.

Analysis on Bidirectional Regulation of Purging and Astringency About Raw and Steamed Products of Rhei Radix et Rhizoma and Their Active Components / 中国实验方剂学杂志

Objective:To elucidate the characteristics of bidirectional regulation of raw and steamed products of Rhei Radix et Rhizoma and their active components, in order to provide scientific basis for clinical rational use of this decoction pieces. Method:Mice were randomly divided into the blank group(distilled water, 10 mL·kg-1), raw rhubarb group(1.62 g·kg-1), steamed rhubarb group(0.972 g·kg-1), raw rhubarb anthraquinone group(0.22 g·kg-1), steamed rhubarb anthraquinone group(0.19 g·kg-1), raw rhubarb tannin group(0.17 g·kg-1) and steamed rhubarb tannin group(0.027 g·kg-1). Each group was divided into 3 batches of 10 mice. Mice in each group were given the corresponding dose by continuous gavage for 7 days, the diarrhea index(EI) of mice in each group was recorded every day. The serum levels of motilin(MTL), vasoactive intestinal peptide(VIP) and epinephrine(EPI) were measured on day 1,3,7. Result:Compared with the blank group, EI of the rhubarb group increased significantly on the 3rd day(Pth day of administration(Prd day(Pth day(Pst day of administration, on the 3rd day of administration, the MTL level in the steamed rhubarb anthraquinone group increased significantly(PPPth day of administration, the MTL levels of the raw and steamed rhubarb tannin groups increased to the level in the blank group, the VIP level of the raw rhubarb anthraquinone group increased significantly(PPConclusion:The combined anthraquinone and hydrolyzable tannin in rhubarb can promote gastrointestinal motility and diarrhea. The effect of astringent intestines is caused by the monomer tannin produced by digestion and decomposition of condensed tannin, which may be one of the mechanisms of bidirectional regulation of rhubarb decoction pieces.

Effect of Longdan Xiegantang on Serum Inflammatory Factors, Related Proteins and Immune Function in Patients with Secretory Otitis Media / 中国实验方剂学杂志

Objective: To explore the effect of Longdan Xiegantang on serum inflammatory factors, related proteins and immune function in patients of secretory otitis media (SOM) with liver and gallbladder wetness-heat Syndrome. Method:Totally 76 cases of SOM with liver and gallbladder wetness-heat syndrome admitted to our hospital from July 2017 to May 2018 were randomly divided into two groups, with 38 cases in each group. Control group was treated with triamcinolone acetonide and ambroxol. In addition to the therapy of control group, observation group was also treated with Longdan Xiegantang. Immunoglobulin (Ig) A, IgG, IgM, CD3+, CD4+, CD8+and NK, interleukin-1 beta (IL-1β), IL-5, IL-8, tumor necrosis factor-α (TNF-α), platelet activating factor (PAF), calcitonin (PCT) and water channel protein-1 (AQP-1), AQP-4, fiber link protein (Fn) and soluble interleukin-2 receptor (SIL-2R) levels of two groups were observed before and after treatment. Curative effect and adverse reaction were observed. Result:①Curative effect, after treatment, the total effective rate of observation group was 92.11%, which was higher than 76.32% of control group, with statistically significant differences (Z=2.108, Pα, PAF, PCT, IL-1β and IL-8 in observation group were lower than those in control group after treatment (PPP+, IgA, IgG and IgM of observation group were lower than those of control group (P+, CD4+, CD4+/CD8+ and NK were higher than those of control group (PConclusion:Longdan Xiegantang has a remarkable effect in treating patients of secretory otitis media with liver and gallbladder wetness-heat syndrome, and can restore symptoms, inhibit inflammatory response, activate cell and humeral immune system, reduce the secretion of AQP-1, SIL-2R and other proteins, and increase the secretion of AQP-4 and Fn proteins.

Gastrointestinal Regulation of Red Yeast Rice on Mice with Syndrome of Food Retention Due to Spleen Deficiency Before and After Fermentation / 中国实验方剂学杂志

Objective: To investigate gastrointestinal regulation of red yeast rice on spleen deficient dyspepsia mice, and provide reference for clarifying mechanism of invigorating spleen to promote digestion of fermented traditional Chinese medicine. Method: Mice were randomly divided into 5 groups, including the blank group, the model group, the unfermented red yeast rice treatment group (1.17 g·kg-1·d-1), the fermented red yeast rice treatment group (1.17 g·kg-1·d-1), the domperidone group (3.9 mg·kg-1·d-1), ten mice in each group were continuous intragastric administration for 10 days. The effects of red yeast rice before and after fermentation on the general behavior, body weight, food intake and gastrointestinal function of spleen deficient dyspepsia mice were compared. The effects of red yeast rice on the gastrointestinal hormone[motilin (MTL), gastrin (GAS), 5-hydroxytryptamine (5-HT), vasoactive intestinal peptide (VIP)] levels in serum of spleen deficient dyspepsia mice were determined by enzyme-linked immunosorption assay (ELISA). The regulation function of red yeast rice on the pathological changes of gastrointestinal tissue of spleen deficient dyspepsia mice was investigated by hematoxylin-eosin (HE) staining. The effect of red yeast rice on gut microbiota of spleen deficient dyspepsia mice was investigated, the primers were designed on bacterial 16S rRNA V3-V4 region sequences and Illumina Miseq platform was used for high-throughput sequencing. Result: Compared with the model group, fermented red yeast rice could recover the body weight and food intake, reduce gastric residual rate (PPEscherichia-Shigella, while increasing the relative abundance of the beneficial bacteria such as Lactobacillus and Bifidobacterium. Conclusion: Fermented red yeast rice can enhance the gastrointestinal function of spleen deficient dyspepsia mice, the mechanism may be related to regulating gastrointestinal hormone level, improving histopathology of gastrointestinal tissue and restoring intestinal flora structure.

Effects of Lindera aggregate of Stir-baking with Vinegar- Aucklandia lappa on Gastric Emptying and Gastrointestinal Hormones in Functional Dyspepsia Liver Depression and Qi Stagnation Model Rats / 中国药房

OBJECTIVE： To investigate the effects of Lindera aggregate of stir-baking with vinegar-Aucklandia lappa on gastric emptying and gastrointestinal hormones in functional dyspepsia liver depression and qi stagnation （FDLDQS） model rats. METHODS： Totally 60 SD rats were randomly divided into blank group （n＝10） and modeling group （n＝50）； FDLDQS model was induced by chronic stress restraint or food deprivation or excessive fatigue in modeling group. After modeling， model rats were randomly divided into model group （normal saline）， L. aggregate of stir-baking with vinegar group （1.62 g/kg， calculated by crude drug）， A. lappa group （1.62 g/kg， calculated by crude drug）， L. aggregate of stir-baking with vinegar-A. lappa group （1 ∶ 1， m/m，1.62 g/kg， calculated by crude drug） and mosapride group （positive control， 1.35 mg/kg）， with 10 rats in each group. Administration groups were given relevant medicine intragastrically once a day； blank group and model group were given constant volume of normal saline intragastrically， for consecutive 14 d. 2 h after last medication， gastric emptying rate and small intestinal propulsion rate of rats in each group were measured by phenol red content method. After HE staining， the morphological changes of antrum tissue were observed under microscope. The contents of motilin （MTL）， gastrin （GAS） and cholecystokinin （CCK） in serum were determined by ELISA method. RESULTS： Compared with blank group， gastric emptying rate and small intestinal propulsion rate of rats were decreased significantly in model group （P＜0.01）； the serum contents of MTL and GAS were decreased significantly （P＜0.01）， while the content of CCK was increased significantly （P＜0.01）. No organic damage was found in all model groups. Compared with model group， L. aggregate stir-baking with vinegar group and A. lappa group， gastric emptying rate and small intestinal propulsion rate of rats were increased significantly in L. aggregate of stir-baking with vinegar-A. lappa group and mosapride group （P＜0.05 or P＜0.01）； serum contents of MTL and GAS were increased significantly （P＜0.01）， while the content of CCK was decreased significantly （P＜0.01）. CONCLUSIONS： L. aggregate of stir-baking with vinegar-A. lappa can accelerate gastric emptying and small intestinal propulsion rate of FDLDQS rats， increase serum contents of MTL and GAS but decrease the content of CCK； its effects are better than that of them alone.