24-10-2016, 03:36 PM
The Prevalence of Irritable Bowel Syndromeamong King Saud University Undergraduate Male Students
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Abstract: The aim of our study was to determine the prevalence of irritable bowel syndrome (IBS) according to the
Rome III criteria and its subtypes among King Saud University (KSU) undergraduate male students and to
describe correlation of symptoms with multiple variables such as exercise, body mass index, family history and
others.
Material and methods: A hard copy questionnaire was constructed by our team in February-march 2013 and 600
questionnaires were handled to undergraduate students of the different colleges at KSU (5 humanitarian colleges,
6 science colleges and 5 health colleges. IBS was estimated by the Rome III criteria.
Results: A total of 509 responders were obtained with mean age 21.4 years (19–25 years range).169 of them
(33.2%) fulfilled the Rome III criteria for IBS and had no organic diagnosis to explain their symptoms and 340
(66.8%) did not fulfill the criteria. Subtypes were: mixed IBS 68%, IBS with diarrhea 17%, IBS with constipation
7%, and unsubtyped IBS 8%. The prevalence of IBS among the different colleges was variable, the highest being
in faculty of medicine (48%) and the lowest prevalence was in the faculty of business and administration
(10.7%).The full description of results in all colleges will be presented.
The prevalence of IBS was higher in those who are more than 22 years old, in slim subjects than in obese ones,
people with chronic diseases, those with family history of IBS and those who eat more frequent fast food. Those
who exercised regularly were less affected, however, there were some variables with no significant association like
smoking.
Conclusion: The prevalence of IBS according to Rome III in undergraduate students at KSU was 33.2% and was
higher in medical students compared to other colleges. Multiple factors may contribute to these findings.
INTRODUCTION AND RATIONALE
Irritable bowel syndrome (IBS) - known also as irritable or spastic colon - is a heterogeneous disorder and a chronic
condition affecting the lower part of the gastrointestinal tract and it is a symptom-based diagnosis [1]. The syndrome may
present with different symptoms, however abdominal pain or discomfort is a hallmark of this condition and the pain might
be associated with diarrhea, constipation, or both. IBS is a functional bowel disorder with no well defined organic cause.
According to changes in bowel habits, IBS is classified into several subtypes: associated with diarrhea (IBS-D), with
constipation (IBS-C), with mixed diarrhea and constipation ( IBS-M), and (IBS-U) for the unsubtyped IBS group.
Change may not be in habits only but may frequency of the bowl movements. Affected patients may also have a feeling of
incomplete evacuation, bloating or abdominal distension. [2][3][4]
Although there is no cure for IBS, there are treatments that attempt to relieve symptoms, including dietary adjustments,
medication and psychological interventions. Patient education and a good doctor-patient relationship are also important.
[5]
IBS has no direct effect on life expectancy. It is, however, a source of chronic pain, fatigue, and other symptoms and
contributes to work absenteeism.[6][7] The high prevalence of IBS[8][9][10] and significant effects on quality of life
make IBS a disease with a high social cost.[11][12] It has also been suggested that a proportion of IBS patients may
develop depression and are thus more likely to commit suicide.[13] Proposed factors for increased suicide rate in IBS
patients include perceived hopelessness and poor quality of services.[
Irritable bowel syndrome is a worldwide syndrome that has a varying prevalence estimates depending on geographical
locations and the diagnostic criteria used. Studies that were done showed a high number of population diagnosed with IBS
affecting 12% of the world population.[5] In addition, this condition is compromising 50%-70% of the gastroenterology
clinic load in the west. [7]
In our country a study was done in Riyadh to study the prevalence of IBS in adult Saudis according to Rome II Criteria.
The prevalence was 11.40% with a significant difference between female and male subjects, (females 14.28%, and males
8.51%). [16]
To the best of our knowledge there was no single study addressing the prevalence of IBS among an undergraduate Saudi
universities students. Therefore, we conducted this study to determine the prevalence of this syndrome among King Saud
University (KSU) undergraduate male students in 2012-2013. We also looked to the influence of some variables which
may be related to the occurrence of this syndrome. This study is designed for the first time during the CMED 305
curriculum time from September 2012.
In our study we used the Rome III Disorders and Criteria to create scientific data to help in the diagnosis of IBS which is
a system developed to classify the functional gastrointestinal disorders (FGIDs) in which symptoms cannot be explained
by the presence of structural or tissue abnormality based on clinical symptoms. Some examples of FGIDs include irritable
bowel syndrome, functional dyspepsia, functional constipation, and functional heartburn. The most recent revision of the
criteria, the Rome III criteria, was published in 2006 in book form, and in a shorter journal supplement in
Gastroenterology. [17]
Hypothesis:
We expect the prevalence of IBS to be higher in our population than the reported among general the population (>12%)
and we also expected the prevalence to be higher among medical students.
Objectives:
The aim of our study was to determine the prevalence of irritable bowel syndrome (IBS) according to the Rome III criteria
and its subtypes among King Saud University (KSU) undergraduate male students and to describe correlation of
symptoms with multiple variables such as exercise, body mass index, family history and others.
2. METHODOLOGY
Study design:
This was a cross sectional study was conducted from February-March 2013, involving a self-administered questionnaire
(translated in Arabic- addendum 1) based on Rome III criteria for diagnosis of IBS [17] that was distributed to male
undergraduate students at KSU in the following colleges (by convenience sampling):
General medical history was also included in the questionnaire together with an objective evaluation of obesity (asking
about height and weight). Age and income level were studied as demographic factors.
Health related conditions were investigated: smoking (dichotomized as “smoker” and “non-smoker”), physical activity
(dichotomized as “Physically active” and “Physically inactive”) and daily sleeping hours.
Body mass index (BMI) was also calculated and subjects were grouped into four categories: underweight (<18.5 kg/m2),
normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥30.0 kg/m2). We also asked about fast food
consumption, whether the subject consumes fast food in addition to the times per week of consumption were all
questioned.
Population:
The study included a sample of 600 subjects (19-25 years old) from a population of 21,289 male undergraduate students,
546 out of 600 completed the questionnaires, 37 questionnaires were excluded because responders reported having
organic bowel diseases leaving 509 participants with proper questionnaires representing final sample size. The sample
size was estimated to be representative for the understudy population using the formula of a single proportion.
Statistical analysis:
Descriptive statistics were performed with SPSS 19.0. Spearman’s correlation and cross-tabulation analysis (Chi-square
test) was used to compare between IBS and non-IBS with different parameters.
We assumed there was a statistical of significant difference is P-value is less than 0.05
Finally, graphs were made by using Microsoft excel.
Ethical consideration and clearance:
The study was approved by the Ethics Committee of College of Medicine in King Saud University. A verbal consent was
taken from all participants prior to questionnaire filling. All participants' information have been treated confidentially and
they're classified as they haven't been shared with any other parties.
CONCLUSION AND RECOMMENDATION
The prevalence of IBS according to Rome III in undergraduate students at KSU was 33.2% and was higher in medical
students compared to other colleges. Multiple factors may contribute to these findings.
Moreover, results revealed some variables that have significant correlations with IBS like: regular exercise, family history
of IBS, fast food intake and body mass index. Unlike smoking which has no significant association with this syndrome.
Based on these study results, the higher the frequency of fast food intake, the higher the risk of developing IBS.
Therefore, decreasing the intake of fast food is recommended. Moreover, a regular physical exercise has shown to be
decreasing the risk of IBS so it’s highly advised.