二甲双胍是治疗2型糖尿病的一线用药，其最常见的药品不良反应是胃肠道反应，潜在的机制目前尚不清楚，且临床干预策略较少。二甲双胍与肠道的关系是研究的热点，近期研究表明胃肠道不耐受的机制可能与肠道因素相关。就肠道与二甲双胍不耐受性的最新研究进展进行综述，并概述治疗策略，为临床应用二甲双胍提供参考。

Metformin is a first-line drug for the treatment of type 2 diabetes, and the most common adverse drug reactions are gastrointestinal reactions. The underlying mechanism is not yet clear, and there are few clinical intervention strategies. The relationship between metformin and the intestinal tract is a hot topic of research. Recent evidence suggests that the mechanism of gastrointestinal intolerance may be related to intestinal factors. This article mainly reviews the advancement of the recent studies about the relevance of the intestinal tract and metformin intolerance, and treatment strategies will be summarized to provide references for clinical application of metformin.