Objective: To investigate the effect of perioperative nutrition management of enhanced recovery after surgery (ERAS) on the intestinal barrier after gastrectomy. Methods: Twenty-two patients with gastric cancer and gastrectomy were treated with perioperative nutrition management according to the ERAS protocol (ERAS group), while 20 cases were only given traditional nutrition management(traditional group). Plasma diamine oxidase (DAO), D-lactic acid (D-LA), and intestinal fatty acid binding protein (IFABP) levels before operation and on the 1st, 3rd and 5th postoperative day were compared between the two groups. In addition, the gastrectomy model of SD rat was established, in which 20 rats underwent perioperative nutrition management according to the ERAS protocol by the enteral route (ERAS group), while the other 20 rats were given traditional perioperative nutrition management by the parenteral route (tradition group), and 10 normal rats were used as control group. Ileal specimens of 10 rats in each group were harvested at 24 h and 72 h after operation, and the pathological scores and microstructures of intestinal mucosa in each group were compared. Results: The plasma DAO, D-lactic acid and IFABP levels of the two group patients on the 1st postoperative day were significantly higher than preoperative level (P<0.01). Compared with the tradition group, in the ERAS group, the DAO level at 1st, 3rd and 5th postoperative day, the D-lactic acid level at 3rd and 5th postoperative day, and the plasma IFABP level on the 1st and 3rd postoperative day were all significantly reduced (P<0.01 or 0.05). Animal experiments showed that pathological scores of intestinal mucosa in the ERAS group were lower than those in the tradition group at 24 h and 72 h after surgery(P<0.05), and ERAS group had less ultrastructural damage of the intestinal epithelial cells compared with the tradition group. Conclusion: Gastrectomy could cause damage to the structure and function of intestinal barrier. The implementation of perioperative nutrition management of ERAS may promote the earlier recovery of structure and function of intestinal barrier.

［Key words］enhanced recovery after surgery; nutrition management; gastrectomy; intestinal barrier; diamine oxidase; D-lactic acid; intestinal fatty acid binding protein