Key words：cinacalcet hydrochloride, activity of gastric acid secretion, gastric emptying, gastrointestinal motility, medicine releasing acetylcholine 〈Abstract〉 After taking cinacalcet hydrochloride, hemodialysis patients with secondary hyperparathyroidism often complain of upper gastrointestinal symptoms. In order to evaluate gastrointestinal function, the activity of gastric acid secretion was examined by measuring intragastric pH, serum gastrin and serum pepsinogen concentration and gastric emptying test was examined by measuring serum acetoaminophen concentration. Cinacalcet elevated serum gastrin concentration, but was independent of gastric acid secretion. Meanwhile cinacalcet delayed gastrointestinal motility. In cases showing delayed gastrointestinal motility and gastric atrophic mucosa, gastrointestinal complication often occurred. Because cinacalcet operates on gastrointestinal tract as calcimetics, it is supposed that gastrointestinal complication is due to suppression of the parasympathetic nervous system. In order to reduce this complication, it is useful to take cinacalcet during gastric emptying time or post hemodialysis and to take digestive medicine together such as medication releasing acetylcholine or prostaglandin to advance gastrointestinal motility. Before using cinacalcet, it is preferable to check for gastric disease, intragastric acid, intragastric mucosal condition, and gastric motility by endoscopic examination. If the mechanism of upper

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