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Little attention has been given to esophageal disorders in diabetes mellitus. Pathophysiology of esophageal motility disorders (EMD) in patients with diabetes mellitus is multifactorial. The aims of the present study were: (a) to evaluate the prevalence of EMD in patients with Type 2 diabetes mellitus and (b) to determine the relationship between EMD and autonomic neuropathy as assessed by heart rate variability (HRV). All the patients completed a questionnaire about diabetes characteristics and gastrointestinal symptoms. Conventional esophageal manometry was performed in all patients. HRV was measured in three different situations (Lying Position 1, standing position, and Lying Position 2). The temporal and frequency domain parameters were considered for analysis. The prevalence of EMD in our patients was 60.5% ( n = 23). Low score physical activity was significantly more frequent in patients with EMD ( p = .03). There was an increase in sympathetic activity represented by the low frequency (LF) parameter ( p = .027) in the presence of EMD. Whereas parasympathetic modulation of heart rate represented by the high frequency (HF) parameter ( p = .027) was declined in patients with EMD compared to those without. The LF/HF ratio was significantly higher ( p = .002) in patients with EMD. EMD were prevalent in diabetes mellitus and were associated to autonomic nervous system dysfunction predominantly at the parasympathetic component.

Aims: To estimate the prevalence of lower digestive symptoms according to the Rome III criteria among diabetic patients of type 2, and second to identify the factors associated with the digestive symptoms among these subjects., Methods: A cross-sectional study was carried out among recruited diabetes mellitus type 2 patients from basic health centers at Sousse and Monastir (Tunisia). Diagnosis of digestive symptoms was based on Rome III criteria. We studied the influence of socio-demographic characteristics, life style, diabetes mellitus characteristics, somatization, psychological state (HAD scale) and quality of life (SF-12 scale) on the prevalence of digestive symptoms., Results: Four hundred and seventeen patients were enrolled in our study. The average age was 61.3±10.4 years with a female predominance (68.8%). The overall prevalence of digestive symptoms was 44.8%. The main digestive symptoms found were abdominal bloating (23%), diarrhea (11.7%), constipation (8.6%), irritable bowel syndrome (8.6%) and fecal incontinence (8.1%). Logistic regression showed that digestive intolerance (OR=2.28; 95%CI[2-5.31]), request care for a digestive problem (OR=2.95; 95%CI [1.49-5.83]), anti-acid treatment (OR=4.22; 95%CI [1.13-15.69]), diabetic retinopathy (OR=2.66; 95%CI [1.52-4.7]), somatization (OR=1.75; 95%CI [1.06-2.88]), and a deteriorated mental health state (OR=2.8; [1.66- 4.72]) were the independent factors associated with digestive symptoms., Conclusion: Digestive symptoms cause an important request for care and have a negative impact on quality of life of diabetics. Thus digestive symptoms should be systematically diagnosed in patients with type 2 diabete.