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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 13
| Issue : 1 | Page : 13 |
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The prevalence and risk factors of irritable bowel syndrome in Saudi Arabia in 2019
Naif H Alqahtani1, Mohammad Eid M Mahfouz2
1 Medical Graduate, College of Medicine, Taif University, Saudi Arabia
2 Department of Surgery, College of Medicine, Taif University, Saudi Arabia
| Date of Submission | 19-Aug-2020 |
| Date of Acceptance | 13-Mar-2021 |
| Date of Web Publication | 19-Jan-2022 |
Correspondence Address:
Naif H Alqahtani
College of Medicine, Taif University, Taif City, 21944
Saudi Arabia
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijpvm.IJPVM_486_20
Background: Irritable bowel syndrome (IBS) is a common chronic functional gastrointestinal (GI) disorder. The aim of this study is to assess the prevalence of IBS and its risk factors among the general population of Saudi Arabia, as there is no previous study has done so. Methods: A cross-sectional study was carried out to evaluate the prevalence of IBS, IBS subtypes and IBS risk factors among the general population of Saudi Arabia from June 22 to November 30, 2019. A designed questionnaire that is based on ROME IV criteria and licensed from Rome Foundation was used. A total of 1,680 eligible individuals from different parts of Saudi Arabia took part in this national survey and were included in the statistical analysis. The statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) program (version 22). Results: The prevalence of IBS in the study was 18.2%. IBS-M was the most common subtype among IBS patients (42.3%). Risk factors that are significantly associated with IBS were shown to be smoking habits, gastroesophageal reflux disease (GERD), food allergy, anxiety, psychological stress, family history of IBS, regular use of non-steroidal anti-inflammatory drugs (NSAIDs), history of infection before occurrence of symptoms and residence in the south of Saudi Arabia (P < 0.05*). Conclusions: IBS is prevalent in Saudi Arabia. The most common risk factor among IBS patients is a positive family history of IBS (80%). Raising public awareness and further prospective studies are both advocated and needed.
Keywords: Anti-bacterial agents, body mass index, contraceptive agents, genetics
How to cite this article:
Alqahtani NH, Mahfouz ME. The prevalence and risk factors of irritable bowel syndrome in Saudi Arabia in 2019. Int J Prev Med 2022;13:13 |
| Introduction | |  |
IBS is not an uncommon chronic functional GI disorder as it affects 9%-23% of the population globally.[1] It was estimated that one in every five individuals suffers from IBS during a lifetime.[2] Additionally, there is an increasing percent of patients seeking medical advice for their IBS symptoms, which is estimated to be approximately 12% of primary care clinic visitors. They represent the main group of patients in gastroenterology clinics.[3] However, a recent systematic review and meta-analysis found that IBS prevalence was 9.2% applying Rome III criteria and 3.8% applying Rome IV criteria.[4]
The pathophysiology of IBS is still inadequately understood and the etiology of IBS remains without confirmed known causes. Yet, some associated risk factors have been implicated on the pathogenesis of the disease.[5],[6],[7] A “biopsychosocial” model[8],[9] has been introduced recently as an attempt to integrate and harmonize the different factors (genetic, environmental and psychological) that could act in a synergistic way to produce these symptoms.
The incidence of IBS was found to be the highest in the age group between 20 and 40 years .[10] Also, some reports suggested that the incidence of IBS is higher in females compared to males.[11],[12],[13],[14] IBS can also be influenced by genetic implications, where family history can play a role in the development of IBS in up to 30% of the patients.[15],[16]
Food allergies have also been correlated to the occurrence of IBS symptoms.[17],[18] However, the correlation between smoking and IBS remains to be determined.[19] Additionally, psychological stress is a significant contributing factor for the occurrence of IBS.[20],[21] Abuse in childhood or adulthood is evidenced now to be associated with IBS, although whether it is of etiological importance is controversial.[22] Anxiety and depression are also common in IBS.[4],[23]
To the best of our knowledge, this is the first study to evaluate the prevalence and risk factors of IBS in Saudi Arabia. Therefore, the aim of the present study is to estimate the local prevalence of IBS in Saudi Arabia and to identify the risk factors of this syndrome.
| Methods | | |
Study design
A cross-sectional study to assess the prevalence of IBS and its risk factors among the communities of Saudi Arabia.
The minimum sample size that should be achieved is 384 subjects that represent Saudis who age 18 or older (13,815,725 million) with a confidence level (CL) of 95% and confidence interval (CI) of 5%. The samples of 1,680 individuals were collected randomly using a self-reporting questionnaire, during the period from June 22 to November 30, 2019. The questionnaire is based on ROME IV criteria and licensed from Rome Foundation.[24] The Research Ethics Committee of the Taif University (40360159) approved our study on April 30, 2019.
Data collection
A questionnaire was designed to collect the data and was shared as an online questionnaire through the social media applications such as Twitter, Facebook, Instagram, WhatsApp, and Telegram. The questionnaire collection was also conducted by trained medical students through interviews with the general population in the parks, malls and universities. We excluded all participants who were under 18 years old as the questionnaire was only for adults. The questionnaire consisted of the following:
- Sociodemographic characteristics (age, gender, marital status, residence, education, occupation and body mass index, BMI)
- Characteristics of medical, psychiatric and family history (blood groups, smoking habits, GERD, food allergy, depression, anxiety, psychological stress, history of emotional abuse, history of physical abuse, history of sexual abuse, family history of IBS, regular use of NSAIDs, pelvic surgery and using oral contraceptive pills)
- A designed questionnaire for diagnosing IBS in adults based on ROME IV criteria that is licensed for the author from Rome Foundation
- History of infection before occurrence of symptoms, and antibiotic use before occurrence of symptoms in IBS patients and in people with IBS-like symptoms.
Statistical analysis
All data were recorded in a validated and pre-designed excel sheet. Data were represented in terms of valid percentages and frequencies for categorical variables; mean ± standard deviation (SD) expresses continuous variables; and BMI was calculated and categorized. Data were analyzed using the SPSS program (version 22) to perform all statistical calculations. We used Chi-square and t tests to assess the association between IBS and potential risk factors. P values ≤0.05 were considered statistically significant. Potential risk factors for IBS with a P value ≤0.5 were subjected to a binary logistic regression analysis to consider multiplicity.
Ethical considerations
The Research Ethics Committee of the Taif University (40360159) approved our study. Consents of participants were obtained from them to be involved in this study. This study was conducted in compliance with the Declaration of Helsinki. All authors had access to the study data and reviewed and approved the final manuscript.
| Results | | |
Patients' demographics
This study included 1,680 participants, who had mean age 32.2 ± 12.3, with a minimum age of 18 years and a maximum age of 75 years. Sixty-four percent of the samples were of females, while 36% were males. As for the marital status, 50.3% of the responders were single, while 1.6% were widowed.
The place of residence was also evaluated. About 74.3% of the responders were from the western area in Saudi Arabia, while only 3.4% were from the northern area. As for education, only 0.6% of the participants were illiterate, while 79% of the participants had a university degree or higher. Furthermore, 0.9% were manual workers, while 38.6% were students. The mean and SD of BMI was 26 ± 6.1 kg/m2 and most of the participants had normal BMI. All sociodemographic data are detailed in [Table 1].
Prevalence of IBS, IBS subtypes and the risk factors of IBS
Based on the answers of the participants, it has been revealed that the prevalence of IBS in our research was 18.2% (n = 306). IBS-M was the most common subtype among IBS patients (42.3%), followed by IBS-C (27.2%), IBS-D (21.6%) and IBS-U (8.8%).
The risk factors of IBS
There was a significant association between IBS and the residence in the south of Saudi Arabia (P = 0.0001). There were no statistically significant association between IBS and the other sociodemographic characteristics (P > 0.05). IBS was significantly associated with smoking habits, GERD, food allergy, family history of IBS and regular use of NSAIDs (P < 0.05*) [Table 2]. In contrast, we did not find a significant association between ABO groups and IBS (P = 0.47), nor did we detect a significant association between history of pelvic surgery and IBS (P = 0.14). Using oral contraceptive pills (OCPs) in women was also not associated with IBS (P = 0.98). There was a significant association between IBS and the history of infection before the appearance of IBS symptoms (P = 0.04). There was no statistically significant association between IBS and using antibiotics before the appearance of IBS symptoms (P = 0.89). Family history was the most common risk factor among IBS patients in our study (80%). To identify factors associated with IBS, multiple risk factors with a P value ≤0.05 in [Table 2] were included in a stepwise binary logistic regression analysis. The statistically significant differences in the regression model between IBS and the potential risk factors are documented in [Table 3]. Anxiety was associated with IBS, whereas depression was not. We also noticed that psychological stress was associated with IBS, whereas all forms of abuse (emotional abuse, physical abuse and sexual abuse) were not [Table 3]. | Table 3: Binary logistic regression analysis of characteristics associated with IBS (n=1,680)
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| Discussion | | |
Irritable bowel disease is a common disorder that reduces the quality of patient life.[7] Despite the studies on worldwide prevalence and etiology of IBS, there is not enough data on its prevalence and risk factors among the general population of Saudi Arabia.
The aim of the present work was to explore the prevalence and risk factors of IBS in Saudi Arabia. It was demonstrated that the prevalence of IBS in this study was 18.2% (applying Rome IV criteria), which is within the international prevalence for IBS.[1] However, this percentage is higher than the results of a recent systematic review and meta-analysis from 34 countries that comprised 82,476 individuals (3,8%).[4]
Consistent with a recent study that was conducted by Alharbi et al.,[25] which investigated the prevalence of IBS and the most common subtypes among the northern Saudi population employing Rome IV criteria, we found that the most common subtype is IBS-M followed by IBS-C, -D and -U. However, Alharbi et al.[25] did not clearly address IBS-U prevalence in their study, which we found to be 8.8% in our study. Yet, the present study used a larger sample size and included all parts of Saudi Arabia, which strengthened its findings. This study also revealed that IBS was significantly associated with the population in the south of Saudi Arabia.
Consistent with a previous meta-analysis,[26] we did not detect a statistically significant association between age and IBS.
We did not find the prevalence of IBS to be significantly higher in women than in men. This result is consistent with a previous systematic review and meta-analysis that was conducted on 56 studies containing 1,88,229 eligible subjects.[27]
There was no statistically significant association between marital status and IBS, which is consistent with a previous study that included 1,082 individuals in a university-based population.[28] This result contrasts other studies. However, these studies are conflicting as to whether IBS is more common in married[29] or unmarried people.[30]
In contrast to the other studies, education level was not significantly associated with IBS; however, these studies are also conflicting if education is directly[31] or inversely[30],[32] proportional to IBS.
Contrary to previous studies,[31],[32],[33] we did not find employment to be associated with IBS.
Regarding controversies about marital status, education levels and employment; and whether they are risk factors or not, we attributed those differences to cultural differences in each community's view on different social status. This status may be variably associated to individuals of those communities with psychological factors, such as anxiety and psychological stress, which are risk factors for IBS in themselves.
In contrast to previous studies,[32],[34] the present work did not show a significant association between IBS and BMI, which is consistent with another study that was conducted on 1,978 individuals.[35] Studies that found BMI associated with IBS are conflicting as to whether IBS increases with increasing or decreasing BMI. We agree with Pickett-Blakely et al.[36] that understanding the mechanisms whereby obesity is linked to IBS symptoms, understanding the clinical course of IBS in obese persons, and determining the effect of weight loss interventions on IBS symptoms can help in determining the correlation between IBS and BMI although his speech was confined to obesity.
In our research, there was a significant difference in IBS prevalence between smokers and non-smokers. A systematic review that included 33 articles comparing smoking prevalence between subjects with IBS and those without concluded that the association between smoking and IBS remains to be determined.[19]
IBS was associated with GERD, a finding that is in line with the previous studies.[37],[38] However, this finding does not indicate the causal direction of the observed associations, which is outside the area of the present work.
Food allergy was also associated with IBS, which is consistent with the previous studies.[17],[18]
In agreement with the previous results,[4],[23] this study revealed that anxiety was associated with IBS. However, after applying a binary logistic regression, depression was not associated with IBS.
In the literature, the association between IBS and emotional and physical abuse is less distinct than the association between IBS and sexual abuse.[39] In our study, all forms of abuse (sexual, emotional and physical) were not associated with IBS in the logistic regression model.
As other studies have shown,[20],[21] the present study has also shown that psychological stress was associated with IBS.
A significant difference was observed in IBS prevalence between subjects with positive family history of IBS and those without, which is consistent with the other studies.[15],[16]
In contrast to the other studies,[35],[40] this study showed that regular use of NSAIDs was significantly higher in IBS patients. In a case-control study, Keszthelyi et al. found that NSAIDs were more frequently used in IBS patients compared to controls.[41] Although NSAIDs are hypothesized to increase intestinal permeability in IBS patients, which allows luminal antigens to enter the lamina propria, thereby, eliciting an immune and inflammatory reaction,[42] further prospective cohort studies are needed to confirm NSAIDs as a risk factor for IBS and to help identify the etiological nature of this association.
There was no significant difference in IBS prevalence between patients with history of pelvic surgeries and patients without. Other studies have shown contrasting results from this study.[43],[44] Further studies in which it is determined whether IBS is an effect for pelvic surgeries or whether pelvic surgeries are done mistakenly for misdiagnoses of IBS pain might solve this conflict. Other studies that determine mistaken pelvic surgeries owing to lower pain threshold in IBS patients could explain the different results between our study and other studies.
Our study did not find any significant association between IBS and oral contraceptive pills or antibiotic use before the occurrence of IBS symptoms. However, we observed a significant association between IBS and a history of infection before the symptoms occurred.
| Conclusions | | |
IBS is prevalent among the Saudi population. IBS-M was the most common subtype among IBS patients in Saudi Arabia. The contributing factors for IBS in Saudi Arabia were shown to be smoking habits, GERD, food allergy, anxiety, psychological stress, family history of IBS, regular use of NSAIDs, history of infection before occurrence of symptoms and residence in the south of Saudi Arabia.
Raising public awareness in the community about the risk factors for this common syndrome is advocated.
Further prospective studies are needed to determine the association of controversial risk factors with IBS.
Acknowledgments
We would like to extend special acknowledgement to Yousef Zabin Alotaibi, Doha Abdulrahmman Alsukhayri, Nawaf Hussain Alqahtani, Montaha Mohammad Dabi, Abdulaziz Hameed Althumali, and Raghad Hamza Omar for their active role in data collection.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]
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