studies suggest that gi symptoms affect quality of life adversely ( 610 ) and represent a substantial cause of morbidity in patients with diabetes ( 3 ) , the available epidemiological data relating to the prevalence of gi symptoms in diabetes is conflicting and can be challenged on methodological grounds ( 2 , 11 ) . ( 12 ) evaluated the prevalence of gi symptoms in a non - selected , population - based cohort of 110 young adult patients with long - standing type 1 diabetes mellitus , compared with age- and sex - matched control subjects . in the patients with diabetes , there was an increased prevalence of upper gi symptoms , such as anorexia and vomiting , whereas there was no difference in the frequency of symptoms referable to the lower gi tract . the prevalence of gi symptoms was significantly greater in women than in men and in those subjects with the worst glycemic control , as assessed by glycated hemoglobin concentrations . ( 13 ) found that the prevalence of upper gi symptoms including abdominal pain , constipation , and diarrhea was similar in patients with diabetes and controls . in that study , only middle - aged patients with type 1 or type 2 diabetes mellitus who were treated with insulin or oral hypoglycemic drugs were evaluated , and the questionnaire used to evaluate symptoms was not a validated measure . finally , a recent community - based study from the united states ( 13 ) failed to detect differences in prevalence rates for gi tract symptoms in persons with or without diabetes mellitus , except for a lower prevalence of heartburn and an increased prevalence of constipation or laxative use in residents with type 1 diabetes mellitus . the findings , however , were surprising as the study did not report a single subject with diarrhea . furthermore the controls for type 1 diabetes mellitus reported more constipation compared with the older group of controls for persons with type 2 diabetes . furthermore , the authors reported no differences in peripheral neuropathy and minor differences in autonomic neuropathy between subjects with type 1diabetes and age - matched controls . we devised an epidemiological survey using a questionnaire , and we hypothesized that troublesome gi symptoms would be more prevalent in patients with diabetes compared with community controls , after adjusting for age and sex . this descriptive , cross- sectional , referral- based study was conducted during 2003 in tabriz , iran . among the diabetic patients who had been referred to a metabolic clinic a questionnaire has been designed including age , sex , past medical history , gi symptoms and signs , type of diabetes mellitus , duration and complications of diabetes mellitus . comparisons between means were carried out using the student 's unpaired and paired t test . the study project was endorsed by the ethics committee of department of endoscopy sina university , tabriz university of medical sciences , iran . . thirty three percent of studied patients had appropriate control on their hyperglycemia and 67% of patients had poor controlled diabetes ( 40.2% were male ) . the prevalence of complications of diabetes reported in our diabetic patients were 74% ( 30% were male ) . forty two diabetic patients had the history of hypertension , 26 persons had the history of hyperlipidemia and 61 parsons had hypertension and also hyper lipidemia . neuropathies in complicated diabetic patients were reported in 23.8% compared with 19.2% in diabetic without any other complications . gi symptoms and signs were reported in 92% of patients and 40% of them were male . the most common symptoms were constipation followed by bloating , mass protruding through anus , abdominal pain , and dyspepsia ( table 1 ) . sixty three percent of them had poor controlled diabetes and 74.1% had diabetes for more than 5 years . the most frequently observed sign was abdominal tenderness on deep palpation ( table 2 ) . gi symptoms prevalence in different age groups was as follow : 71.4% in aged 20 - 29 years , 77.7% in 30 - 39 years , 82.3% in 40 - 49 years , 93.3% in 50 - 59 years , 97.2% in 60 - 69 years , and 100% in 70 - 79 years . diarrhea , with symptoms lasting more than 2 weeks , was reported in 3% of patients . frequency of gastrointestinal symptoms in patients with diabetes mellitus , tabriz , iran frequency of gastrointestinal signs in patients with diabetes mellitus , tabriz , iran prevalence rates of gi symptoms and signs in studied population increased with age , 97.2% of subjects in the 60 - 69 year age group . in our previous study on this age group constipation was the most common symptom , 29.1% in diabetic patients with complications and 18.1% in diabetic patients without complications ( 14 ) . in the current study there is a relationship between constipation , poor controlled diabetes ( 62.7% ) , duration of diabetes ( 74.1% ) and the complication of diabetes ( 71.6% ) . diarrhea lasting longer than 2 weeks had been reported in 3% patients , in comparison with a much lower prevalence in the general population ( 0.4% ) ( 14 ) . another study reported diarrheal symptoms had a prevalence of 3% in complicated diabetic patients and 1.9% in non complicated diabetic patient ( 15 ) . this study also reported a relationship between diarrhea more than 2 weeks and uncontrolled diabetes mellitus ( p= 0.001 ) . the prevalence of heartburn in our study was 25.5% , but this prevalence was 3% in general population . reflux in our previous study reported 8.3% in diabetic patients without any complications and 18.9% in complicated diabetic patients , and 11.6% in patients with dmi and 22.9% in control group , and 19.8% in patients with dm ii ( 14 ) and 24.3% ( 15 ) in control group and these results were similar to our study . in our study constipation , melaena and mass protruding anus have not been reported in dm i. there was no relationship between type of diabetes and abdominal pain , dyspepsia , diarrhea more than 2 weeks , bloating , and heartburn . abdominal hernia had been reported in 7% of patients , in compare to general population 0.5% ( 14 ) . seventy five percent of the abdominal hernias were inguinal hernia and rests were incisional , femoral and umbilical hernias . in our study most patients had incisional and umbilical hernias . the limitation of this study is we investigated the single clinic population and no control group was recruited from a general non - diabetic population . therefore , we suggest that further studies with matched control group may be of interest .
aimto determine the prevalence of gastrointestinal symptoms and signs among persons with diabetes mellitus in a specialist hospital.backgroundgastrointestinal symptoms and signs are common among patients with diabetes mellitus . 
 morbidity frompatients and methodsin this descriptive , cross - sectional study , subjects from the general population with diabetes ( n=200 ) were recruited for this study . 
 subjects were randomly chosen from patients known to have diabetes , ( type i&ii ) , attending the diabetes clinic at sina university hospital , in tabriz during 2003 . 
 the questionnaire recorded gastrointestinal symptoms among the subject population.results91% and 9% of patients had type ii and i diabetes , respectively . 
 sixty seven percent of them had poor controlled diabetes and only 3% had well controlled diabetes . gastrointestinal symptoms and signs 
 were reported in 92% of patients . 
 the common gi symptoms were constipation ( 59.5% ) , followed by bloating ( 44% ) , abdominal pain ( 31% ) , dyspepsia ( 30% ) , and mass protruding through anus ( 22.5% ) . 
 abdominal tenderness on deep palpation was the commonest clinical sign ( 54% ) . 
 gi symptoms were more prevalent in subjects aged 60 - 69 years ( 97.2% ) . 
 seventy four percent of patients with gi signs and symptoms had complications such as neuropathy 61.5% and retinopathy associated with neuropathy 38.5%.conclusionthe prevalence of gi symptoms and signs in the population studies was higher than that reported from other populations , and there is a relationship between glycaemic control and complications of diabetes in diabetic subjects .