Prevalence of Irritable Bowel Syndrome IBS and Its Risk Factors among Medical Students in Hail University
Fatmah Fahad Alreshidi1*, Munira Abdulkarim Alsammari2, Arin Essa Almallahi2, Khulud Saud Alshammari2, Ebtehaj Saud Almughais1, Farida Habib Khan1, Sadaf Anwar3, Dalal Alayed4
1Department of Family and Community Medicine, College of Medicine, University of Hail, Hail, Saudi Arabia.
2College of Medicine, University of Hail, Hail, Saudi Arabia.
3Department of Biochemistry, College of Medicine, University of Hail, Hail, Saudi Arabia.
4Department of Family and Community Medicine, College of Medicine and Medical Sciences, Qassim University, Buraydah, Saudi Arabia.
*Email: [email protected]
ABSTRACT
The irritable bowel syndrome (IBS) incidence and its related risk factors greatly vary among communities. Thus, the present study aimed to evaluate the occurrence of irritable bowel syndrome IBS and modifiable risk factors amongst medical students at the University of Hail, Saudi Arabia. The Methodology of the study involved a cross-sectional examination performed at Ha’il University, Ha’il, Saudi Arabia, during the period from November 2021 to February 2022. About 308 medical students were included in this study. About 21.5% of the participants were previously diagnosed with IBS and 23.9% of the contributors were found to fit Rome IV criteria for IBS diagnosis. Regarding modifiable risk factors, around 63.9% were detected with stress and 63.6% claimed lack of exercise. IBS prevalence amongst medical students at the University of Ha'il was among the relatively higher rates, locally and globally. Stress and physical inactivity were the most modifiable risk factors in this study population.
Key words: Irritable bowel syndrome, Medical students, Risk factors, Rome IV criteria
INTRODUCTION
Irritable bowel syndrome (IBS) is a common chronic efficient gastrointestinal (GI) syndrome, which is more frequent among females. The common features of IBS comprise bloating, abdominal distension, abdominal pain, and different bowel movements with alteration of diarrhea and constipation [1, 2].
Many modifiable risk factors have been linked to the etiology of IBS involved a combined genetic predilection, bowel microbial alternation, changed gut-brain relations, mucosal inflammation, visceral hypersensitivity, and psychosocial aspects could have contributed to IBS progress [3, 4]. Stress and lack of physical activity were also reported as IBS risk factors [5, 6].
The prevalence rates of IBS are usually influenced by the diagnostic criteria employed. The diagnostic method is important for realizing the burden of disease, comparing worldwide subpopulations, creating pathophysiologic investigation, sharing health care and research resources, and highlighting new therapies. There are considerable procedural drawbacks in the epidemiology of IBS, so establishing local and international IBS prevalence rates is challenging. The Rome Foundation Global Epidemiology Study was intended to settle these difficulties and attain more acceptable outcomes [7]. IBS is usually diagnosed by Applying Rome IV or Rome III criteria. It was found that applying the Rome IV criteria has more significant diagnostic acumens than the Rome III principles in the IBS diagnosis, though the clinical relevance is doubtful [8].
Variable prevalence rates of IBS were reported from different regions in Saudi Arabia [9, 10]. Therefore, the present study aimed to measure the irritable bowel syndrome IBS frequency and modifiable risk factors amongst medical students at the University of Hail, Saudi Arabia.
MATERIALS AND METHODS
In this survey, a cross-sectional analysis was performed at Ha’il University, Ha’il, Saudi Arabia, during the period from November 2021 to February 2022. The study involved 308 medical students from the College of Medicine, University of Ha'il. Data were collected using an electronic questionnaire designed for this purpose. The questionnaire was distributed through multiple social media applications. The questionnaire was distributed in Arabic and was taken and validated from the previous study in Riyadh City (Al-Imam Mohammad Ibn Saud Islamic University Riyadh, Saudi Arabia 2020) [11]. The questionnaire consisted of three sections. In the first section, Sociodemographic data were obtained, including sex, age, educational level, occupation, body mass index, and marital status of the medical students. The second section involved questions concerning IBS clinical data, management, knowledge, and awareness about symptoms, diagnosis, and treatment of IBS. The third section involved questions regarding Personal habits & stress risk factors and the etiology of IBS among medical students by their socio-demographic data of IBS. The consent of participants was obtained at the beginning of the questionnaire. Data were evaluated with IBM Statistical Package for the Social Science version 23 statistical software used to carry out the analysis throughout this study. Logistic regression analysis is the preferred method since the variable of interest is a binary outcome, i.e., whether the student has inflammatory bowel syndrome (IBS) or not. A p-value < 0.05 was considered statistically important.
Ethical consent
Each participant consented by introducing acceptance of participation before filling out the questionnaire. The research has been revised and ratified by the research ethics committee (REC), at the University of Ha'il, Saudi Arabia, No: H2021-209.
RESULTS AND DISCUSSION
Three hundred and eight (308) participants complete the questionnaire. Tables 1 and 2 are details of the research group sociodemographic features. Men encompassed 56.5% of the research group, and roughly (54%) which is between 22-25. Most of the study participants are in their clinical years (59%). The most of the participants were single (97%), living in their family home (73%). About (43%) of participants reported a family history of IBS, while 11% of the total sample physicians previously diagnosed them as having IBS.
|
|
|
Figure 1. Description of participants by prevalence rates |
Table 1. Distribution of the study population by demographical characteristics
|
|
|
Total |
Yes (IBS) |
No (IBS) |
||||
|
No |
% |
No |
% |
No |
% |
|||
|
Academic phase |
Pre-clinical |
120 |
39.0% |
28 |
23.3% |
92 |
76.7% |
|
|
Clinical |
181 |
58.8% |
35 |
19.3% |
146 |
80.7% |
||
|
Intern |
7 |
2.3% |
4 |
57.1% |
3 |
42.9% |
||
|
Age in years
|
18-21 |
129 |
41.9% |
26 |
20.2% |
103 |
79.8% |
|
|
22-25 |
165 |
53.6% |
38 |
23.0% |
127 |
77.0% |
||
|
> 25 |
14 |
4.5% |
3 |
21.4% |
11 |
78.6% |
||
|
Gender |
Male |
174 |
56.5% |
30 |
17.2% |
144 |
82.8% |
|
|
Female |
134 |
43.5% |
37 |
27.6% |
97 |
72.4% |
||
|
Body mass index |
Underweight |
46 |
14.9% |
10 |
21.7% |
36 |
78.3% |
|
|
Normal |
151 |
49.0% |
30 |
19.9% |
121 |
80.1% |
||
|
Overweight |
76 |
24.7% |
16 |
21.1% |
60 |
78.9% |
||
|
Obese |
35 |
11.4% |
11 |
31.4% |
24 |
68.6% |
||
|
Marital status |
Unmarried |
299 |
97.1% |
64 |
21.4% |
235 |
78.6% |
|
|
Married |
9 |
2.9% |
3 |
33.3% |
6 |
66.7% |
||
|
Living with whom? |
With my family |
225 |
73.1% |
45 |
20% |
180 |
80% |
|
|
At students housing |
6 |
1.9% |
1 |
16.7% |
5 |
83.3% |
||
|
Alone |
56 |
18.2% |
15 |
26.8% |
41 |
73.2% |
||
|
With friends |
21 |
6.8% |
6 |
28.6% |
15 |
71.4% |
||
|
Family member/friend |
45 |
14.6% |
17 |
37.8% |
28 |
62.2% |
||
Table 2. Distribution of the study subjects by socioeconomic characteristics
|
Category |
Variable |
Total |
Yes (IBS) |
No (IBS) |
|||
|
No |
% |
No |
% |
No |
% |
||
|
Family history of IBS |
Yes |
133 |
43.1% |
13 |
9.8% |
120 |
90.2% |
|
No |
175 |
56.9% |
64 |
36.6% |
111 |
63.4% |
|
|
Type of own car |
Don’t have a car |
10 |
3.2% |
5 |
50.0% |
5 |
50.0% |
|
Small car |
86 |
27.9% |
18 |
20.9% |
68 |
79.1% |
|
|
Intermediate care |
192 |
62.3% |
36 |
18.75% |
156 |
81.25% |
|
|
Big car |
20 |
6.5% |
8 |
40.0% |
12 |
60.0% |
|
|
Who drives the car |
Taxi |
11 |
3.6% |
5 |
45.5% |
6 |
54.5% |
|
My self |
205 |
66.6% |
33 |
16.1% |
172 |
83.9% |
|
|
Private driver |
47 |
15.3% |
12 |
25.5% |
35 |
74.5% |
|
|
Monthly income |
< 5000 SR |
24 |
7.8% |
6 |
25.0% |
18 |
75.0% |
|
5000-10000 SR |
49 |
15.9% |
13 |
26.5% |
36 |
73.5% |
|
|
10000-15000 SR |
66 |
21.4% |
7 |
10.6% |
59 |
89.4% |
|
|
15000-20000 SR |
71 |
23.1% |
18 |
25.4% |
53 |
74.6% |
|
|
> 20000 SR |
98 |
31.8% |
23 |
23.5% |
75 |
76.5% |
|
P: Pearson X2 test; $: Exact probability test; * P < 0.05 (significant)
The IBS predominance based on Rome IV measures in the research was 22% (Table 3). Predominantly IBS in females was more than males (28% and 17%). Among IBS subtypes, mixed (16%) and constipation-predominant (24%) subtypes were dominant. Only 31 (41%) of the total 76 cases were previously diagnosed by a physician.
Table 3. IBS clinical data and management among medical students at the University of Hail, Saudi Arabia (n=67).
|
Clinical data |
No |
% |
|
The onset of having IBS |
||
|
Before university |
22 |
34.4% |
|
During university |
42 |
65.6% |
|
Who diagnosed IBS |
||
|
Physician |
31 |
47.0% |
|
My self |
26 |
39.4% |
|
Family |
9 |
13.6% |
|
Consulted a IBS specialist? |
||
|
Yes |
28 |
41.8% |
|
No |
39 |
58.2 % |
|
Received treatment for IBS |
||
|
Yes |
32 |
50% |
|
No |
32 |
50% |
|
Duration of having treatment |
||
|
No treatment |
35 |
53.0% |
|
< 3 months |
15 |
22.7% |
|
3-6 months |
6 |
9.1% |
|
> 6 months |
10 |
15.2% |
|
How often have you felt discomfort or pain anywhere in your abdomen? |
||
|
Never |
3 |
4.5% |
|
Sometimes |
29 |
43.3% |
|
Most times |
27 |
40.3% |
|
All times |
8 |
11.9% |
|
Does the discomfort or pain persist for 6 months or longer? |
||
|
Yes |
51 |
76.1% |
|
No |
16 |
23.9% |
|
This pain is accompanied by |
||
|
No pain/ Nothing accompanies it |
13 |
19.4% |
|
More desire for defecation |
41 |
61.2% |
|
Less desire for defecation |
7 |
10.4% |
|
Uncontrolled defecation |
6 |
9.0% |
|
Does pain or discomfort improve or stop after defecation? |
||
|
Becomes better |
44 |
65.7% |
|
No change/ No pain |
19 |
28.3% |
|
Worse |
4 |
6.0% |
|
Does this pain increases during the menstrual cycle? |
||
|
Yes |
11 |
28.9% |
|
No |
27 |
71.1% |
|
In the past three months, have you had? |
||
|
Mixed (D&C) |
11 |
16.4% |
|
Diarrhea |
14 |
20.9% |
|
Constipation |
16 |
23.9% |
|
Urgency for defecation |
18 |
15.7% |
|
Sense of incomplete evacuation |
45 |
39.1% |
Regarding Table 3 Personal habits & stress risk factors, about (12%) of participants were smokers, and (36%) practiced physical exercise. It depicts the connection concerning the psychological trait of participants and IBS; 64% of medical students and interns who experienced mental distress during the 6 months prior to the research had IBS. After analysis, the table also revealed the prevalence of IBS among participants who had an anxiety problem (prevalence of IBS was 25.3, 24.0, and 31.2% among students with severe anxiety, moderate anxiety, or slight).
Table 4. Personal habits & stress risk factors and etiology of IBS among medical students by their socio-demographic data
|
Personal habits & stress factors |
Suffered from IBS |
p-value |
|||
|
Yes |
No |
||||
|
No |
% |
No |
% |
||
|
Sleep duration / day |
.000 |
||||
|
< 3 hours |
9 |
50.0% |
9 |
50.0% |
|
|
3-8 hours |
43 |
18.9% |
184 |
81.1% |
|
|
> 8 hours |
15 |
23.8% |
48 |
76.2% |
|
|
Smoking duration |
.000 |
||||
|
Non-smoker |
54 |
19.9% |
217 |
80.1% |
|
|
< 3 years |
3 |
21.4% |
11 |
78.6% |
|
|
3-6 years |
4 |
36.4% |
7 |
63.6% |
|
|
6-9 years |
3 |
50.0% |
3 |
50.0% |
|
|
> 9 years |
3 |
50.0% |
3 |
50.0% |
|
|
Do you have bouts of anxiety, stress, or depression? |
.000 |
||||
|
Yes |
57 |
28.9% |
140 |
71.1% |
|
|
No |
10 |
9.0% |
101 |
91.0% |
|
|
If yes, the degree of stress/anxiety |
.000 |
||||
|
Slight |
14 |
24.1% |
44 |
75.9% |
|
|
Normal |
7 |
18.4% |
31 |
81.6% |
|
|
Moderate |
22 |
29.7% |
52 |
70.3% |
|
|
Severe |
18 |
39.1% |
28 |
60.9% |
|
|
How many hours do you exercise a day? |
.000 |
||||
|
Not practice exercise |
43 |
21.9% |
153 |
78.1% |
|
|
< 1 hour |
3 |
42.9% |
4 |
57.1% |
|
|
1-2 hours |
17 |
18.3% |
76 |
81.7% |
|
|
> 2 hours |
4 |
33.3% |
8 |
66.7% |
|
|
How many cups of coffee do you drink per day? |
.000* |
||||
|
Never / irregular |
14 |
17.9% |
64 |
82.1% |
|
|
1-3 cups |
37 |
18.6% |
162 |
81.4% |
|
|
3-5 cups |
12 |
54.5% |
10 |
45.5% |
|
|
> 5 cups |
4 |
44.4% |
5 |
55.6% |
|
|
You preferred food |
.000* |
||||
|
Proteins |
31 |
22.3% |
108 |
77.7% |
|
|
Carbohydrates |
30 |
21.7% |
108 |
78.3% |
|
|
Fruits & vegetables |
2 |
4.0% |
24 |
96.0% |
|
|
All foods |
4 |
80.0% |
1 |
20.0% |
|
P: Pearson X2 test; $: Exact probability test; * P < 0.05 (significant)
The worldwide incidence of IBS is roughly 11.2% in the overall population, which differs regionally [12]. Our study resulted in a prevalence of 21.5% of IBS among the medical students and interns of Hail University in Hail city, KSA. 23.9% fit Rome IV principles for the IBS diagnosis which is higher than a similar study was done in 2018 in our collage of medicine which reported a prevalence of 18% of medical students are having IBS [13]. In Saudi Arabia, 16.3% of medical doctors have IBS [14] and in Jazan Region, Saudi Arabia, IBS prevalence was 16% [15]. However, our study result is lesser than a study in Japan 25.2% of the male nursing and medical school students have IBS [16]. In Nigeria, 26.1% of medical students also have IBS [17]. In Al-Imam Mohammad Ibn Saud Islamic University Riyadh, Saudi Arabia, the prevalence was 35% among medical students who have IBS [11]. In Najran City, Saudi Arabia, 39.8% of male secondary school students exhibited IBS signs evocative [18]. The disparity of our results with those of the cited published studies may be attributed to the research group variability, diagnostic criteria, age group, and learning environment. The difference in sample size may also be another reason for this difference in disparity. It turns out that IBS is increasing these days worldwide and among medical students at Hail University in Hail city of Saudi Arabia. There was no substantial alteration in terms of the occurrence of IBS between male and female participants. This result would mean the gender is unrelated to IBS, which means everyone can get it. In this study, stress (63.9%) and lack of exercise (63.6%) are the highest risk factors for IBS. This study confirms that medical students experience increased stress. In this study, the habits (stress, sleep duration, lack of exercise, drinking coffee, and type of food show a highly significant association with IBS.
CONCLUSION
IBS prevalence amongst medical students at the University of Ha'il was among the relatively higher rates, locally and globally. Stress and physical inactivity were the most modifiable risk factors in this study population.
ACKNOWLEDGMENTS : The authors would like to thank all medical students at the college of medicine, the University of Ha'il for their generous contribution to this study.
CONFLICT OF INTEREST : None
FINANCIAL SUPPORT : None
ETHICS STATEMENT : None
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