|Year : 2020 | Volume
| Issue : 4 | Page : 555-560
Prevalence and risk factors of ibs among medical and nonmedical students in the jouf university
FA Wani1, AH Almaeen1, AH Bandy2, A Thirunavukkarsu2, TA Al-Sayer3, A Flah3, K Fayed3, MM Albalawi3
1 Department of Pathology, College of Medicine, Jouf University, Al-Jouf, Saudi Arabia
2 Department of Community Medicine, College of Medicine, Jouf University, Al-Jouf, Saudi Arabia
3 MBBS Students, College of Medicine, Jouf University, Al-Jouf, Saudi Arabia
|Date of Submission||09-Oct-2018|
|Date of Acceptance||12-Dec-2019|
|Date of Web Publication||4-Apr-2020|
Dr. F A Wani
Department of Pathology, College of Medicine, Jouf University, Al-Jouf
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Irritable bowel syndrome is common in the community and its prevalence is higher among the medical students. Aim: The current study was carried out to estimate the prevalence and evaluate the risk factors of irritable bowel syndrome among medical and nonmedical students of the Jouf University. Subjects and Methods: This cross-sectional study was carried out among medical and nonmedical students of the Jouf University. Study targeted 200 medical and nonmedical students using the convenience sampling technique. A self-administered questionnaire was adopted for the study and consisted of three parts with questions on demographic characteristics, lifestyle, eating habits, academics, and irritable bowel syndrome. Descriptive statistics were carried out to present the demographic characteristics. Chi-square test, odds ratio with 95% CI was calculated for analyzing differences between study variables using SPSS version-16. Multivariate analysis of lifestyle and dietary predictors of IBS was carried out by the enter method. Results: With a response rate of 90.5%, 181 students completed the questionnaire. Around 53 (29.28%) were found to be suffering from IBS with 41 (77.35%) being males. Male gender, married status, and living status of participants were significantly associated with the occurrence of IBS. Prevalence of IBS was found to be more in students who were from the medical college (P = 0.000), students who smoke (P = 0.003), who slept less than 8 h (P = 0.042), and students who often take carbonated drinks (P = 0.003). Smoking, frequency of exercise, coffee intake, and intake of carbonated drinks were strong predictors of IBS on multivariate analysis of lifestyle and dietary factors. Conclusion: We conclude that there is an increased prevalence of irritable bowel syndrome among medical students. Male gender, married status, living in hostel, smoking, less than 8 h sleep, and carbonated drinks were predictive factors for IBS in our study. We recommend screening of medical students for irritable bowel syndrome and institution of interventional measures.
Keywords: Irritable bowel syndrome, medical students, prevalence
|How to cite this article:|
Wani F A, Almaeen A H, Bandy A H, Thirunavukkarsu A, Al-Sayer T A, Flah A, Fayed K, Albalawi M M. Prevalence and risk factors of ibs among medical and nonmedical students in the jouf university. Niger J Clin Pract 2020;23:555-60
|How to cite this URL:|
Wani F A, Almaeen A H, Bandy A H, Thirunavukkarsu A, Al-Sayer T A, Flah A, Fayed K, Albalawi M M. Prevalence and risk factors of ibs among medical and nonmedical students in the jouf university. Niger J Clin Pract [serial online] 2020 [cited 2020 Nov 30];23:555-60. Available from: https://www.njcponline.com/text.asp?2020/23/4/555/281924
| Introduction|| |
Functional gastrointestinal disorders (FGIDs) are quite common in the community and are often underestimated., FGIDs especially the irritable bowel syndrome (IBS) are common chronic bowel disorders that have been found to affect 10% to 25% of populations.,,, They cause negative effects on the health thereby reducing the quality of life and resulting in high healthcare costs. FGIDs are highly prevalent and constitute up to 50% of the consultations in gastroenterology.
Irritable bowel syndrome (IBS) is a common chronic FGID distinguished by the presence of abdominal discomfort in the abdomen with changes in bowel habits in the absence of any inflammatory or neoplastic pathology., The etiology of IBS is not clear although psychological, social, and biological factors have been well known to play a role in its etiopathogenesis.,,,, The diagnosis of IBS is based on clinical findings and the exclusion of other disorder. Irritable bowel syndrome (IBS) is among the most common disorders seen by the physicians although most of the people living with this disorder do not even acknowledge its symptoms. United States records 2.4 to 3.5 million physician visits yearly for IBS despite the fact that bulk of the people having symptoms do not seek medical advice. In the United States alone, it amounts up to 12% of total visits to primary care providers being the most common disorder diagnosed by gastroenterologists.
It is worth noting that many studies regarding IBS have been done in the Middle East and many of these studies have found an increased incidence of IBS in the medical students.,,, Medical students remain under constant stress throughout their study periods with longer duration of courses, too many exams, and difficult duty hours. This increased stress partly explains the high prevalence of IBS seen among the medical students.,,,,,, A study about the prevalence of IBS among medical students from Saudi Arabia revealed prevalence rates of 31.81%.
There is a dearth of literature incorporating studies involving Medical and Non-medical Students. A study from China done by Chu et al compared different colleges for the prevalence of functional bowel disorders (FBD) and found that the risk in the medical students was higher as compared to other colleges. Our research will study the prevalence and risk factors of IBS in medical and nonmedical students in Jouf University, Sakaka.
| Subjects and Methods|| |
This cross-sectional study was carried out among medical and nonmedical students of Jouf University with an objective to assess the prevalence of IBS among medical and nonmedical students and to evaluate the risk factors associated with IBS.
By employing a convenience sampling method, 200 students were targeted from various colleges of Jouf University. The study was conducted from January 2016 to March 2016. Apparently, healthy students from one medical and four nonmedical colleges were included in this study. The selection of the students was done randomly in their classes during the lectures.
Written informed consent was taken from all the students prior to completing the self-administered questionnaires. The ethical committee of the college of medicine approved the study protocol.
Tools for data collection: A self-administered questionnaire was used in this study. The questionnaire consisted of three parts; first part recorded the demographic characteristics of the participants, the second part consisted of questions regarding lifestyle, eating habits, and academics of the participants, and the third part consisted of the questions specifically directed on irritable bowel syndrome.
Data were analyzed by a statistical package of social sciences (SPSS) Version 16. Chi-square (X2) test was applied to determine the association between study variables. Yate's correction was done for multiple comparisons. Odds ratio (OR) with a 95% CI was calculated using Epi-Info. A P- the value of less than 0.05 was considered statistically significant. Multivariate analysis of lifestyle and dietary predictors of IBS was carried out by the enter method.
| Results|| |
Results showed that 181 participants completed the questionnaire giving a response rate of 90.5%. One hundred and six (58.6%) participants were males and 75 (41.4%) were females, of which 37 (19.3%) participants were married and 144 (80.7%) were single. Ninety (49.7%) participants were from the medical college and 91 (50.3%) were from nonmedical colleges. Nearly 123 (68%) participants were living with their family and 58 (32%) were living in hostels [Table 1].
|Table 1: Demographic characteristics of study population (n=181). Data shown are n (%)|
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Results showed that 53 (29.28%) were suffering from IBS with 41 (77.35%) being males. Out of 90 medical students, 38 (42.22%) were affected by the IBS. Out of 91 nonmedical students, 15 (16.4%) were affected by the IBS [Table 2]. Gender of the participant showed a significant relationship with the occurrence of IBS (P = 0.039); IBS was significantly higher among students of medical college compared to students of nonmedical colleges (P = 0.000); unmarried status of the participant and living with family were observed as protective factors for IBS (P = 0.0037 and P = 0.000, respectively). No significant relationship was found in the occurrence of IBS and the level of parent's education or with parent's marital status [Table 2].
|Table 2: Comparison of demographic characteristics of students with and without IBS|
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Prevalence of IBS was found to be significantly higher among participants who smoke as compared to nonsmokers (P = 0.003). Prevalence of IBS was found to be more in participants who sleep less than 8 h/day as compared to students who sleep more than 8 h/day and was statistically significant (P = 0.042). Similarly, the prevalence of IBS was found to be more in participants who exercise ≤1 day per week as compared to participants who exercise more but did not reach statistical significance [Table 3].
|Table 3: Comparison of lifestyle factors between students with and without IBS|
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IBS was found to be more prevalent in participants who often take carbonated drinks as compared to participants who take it less often with statistical significance of P = 0.003. The relationship between IBS and consumption of other foods (coffee, meat, and fruits) was found to be statistically insignificant [Table 4].
Smoking, frequency of exercise, coffee intake, and intake of carbonated drinks were strong predictors of IBS on multivariate analysis of lifestyle and dietary factors [Table 5].
Among the symptoms of IBS, pain/discomfort in the abdomen relieved by defecation (75.47%) and change in the frequency of stools (71.69%) were most frequent symptoms observed among students with IBS [Table 6].
| Discussion|| |
IBS has become prevalent worldwide in recent years among the young adult community, college, and university students, in general, since they have a similar diet, lifestyle, educational situation, and so on. Overall, the prevalence of IBS was found to be 29.3% in our study. Out of 90 medical students, 38 (42.22%) were affected by the IBS whereas it was 16.4% for nonmedical students. Increased prevalence of IBS ranging from 28.3% to 35.5% among the medical students has been reported in many previous studies.,,,
IBS was more prevalent in the male students when compared to female students with a statistically significant relationship (P 0.039). Some studies like those done by Okeke et al. (2009), Tan et al. (2003), and Husain et al. (2008) have documented a higher prevalence in males as in our study;,, however, most of the other studies have found that the prevalence of IBS was higher in women the reasons being increased consultation rates, mental problems, and sleep disorders.,,, For females, students with low grade had a higher prevalence of IBS. Gender differences in IBS and increased rates in females have been proposed to be due to many reasons such as differences in response to stress and pain; sex hormonal effects on gastrointestinal function. Increased prevalence in males in our study may be attributed to the various factors such as increased expectations from family and society, family commitments, stressful education, and inability to handle the stress. Decreased prevalence in females in our study may be attributed to the cultural factors which may hinder them to reveal their symptoms.
The IBS was more prevalent among medical students than nonmedical students in our study with a statistically significant relationship (P = 0.000). Our results are in concordance with the results of previous studies.,,,, This may be attributed to the constant stress being faced by the medical students throughout their study periods with longer duration of courses, too many exams and lots of study material.
Living status of the students correlated positively with the prevalence of IBS (P = 0.000). Students living away from their families in hostels were affected more than the students living with their families. Similar results have been found by Mansour-Ghanaei et al. (2011) and Ibrahim et al. (2013) in their studies., Married students were affected more than the unmarried with significant P value of 0.0037. Our results were in agreement with those of Husain et al. (2008), Khoshkrood-Mansoori et al. (2009) and Farzaneh et al. (2013).,,
Prevalence of IBS was found to be more in participants who smoke as compared to nonsmokers and was statistically significant (P 0.003). Some studies have found a strong positive association between smoking and IBS but most of the others have failed to find a significant association.,, Prevalence of IBS was found to be more in participants who sleep less than 8 h/day as compared to students who sleep more than 8 h/day and was statistically significant (P 0.042). Although the prevalence of IBS was found to be more in participants who exercise ≤1 day per week but statistically, the relationship was insignificant. In a study done by Ibrahim et al. (2013) on medical students and interns in King Abdulaziz University, Jeddah, they found significantly decreased prevalence of IBS in the students practicing physical exercise but could not find any relationship with smoking and sleep. Some researchers have also found a high prevalence of IBS in people who do less exercise, while others have found an increased prevalence of IBS in people who sleep less.,
We found that IBS was more common in participants who often take carbonated drinks as compared to participants who take it less often and the relationship was statistically significant (P = 0.003). Our study failed to find a statistically significant relationship between IBS and consumption of other foods (coffee, meat, and fruits). Liu et al. (2014) in their study found a positive relationship between the intake of seafood diet and IBS but did not find any relation with the consumption of other foods. Ibrahim et al. (2013) and Jung et al. (2011) in their study found no statistically significant differences between the intake of different food items and the prevalence of IBS.,
Smoking, frequency of exercise, coffee intake, and intake of carbonated drinks were strong predictors of IBS on multivariate analysis of lifestyle and dietary factors.
Among the symptoms of IBS; pain/discomfort in the abdomen relieved by defecation (75.47%) and change in the frequency of stools (71.69%) were most common. Changes in fecal consistency were observed in 52.83% of the patients. Khoshkrood-Mansoori et al. (2009) also found abdominal pain or discomfort to be the most common symptom (94%) followed by changes in fecal consistency (78%) and changes in bowel frequency (70%).
| Conclusion|| |
We conclude that the prevalence of IBS among medical students is more than nonmedical students. Male gender, married status, and living in hostel were predictive factors for IBS in our study. Increased prevalence was found in the smokers and people taking carbonated drinks but no relation could be established with the intake of other foods, exercise and sleep.
We recommend screening of medical students for IBS because of increased prevalence so that necessary interventional measures may be instituted.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Halder S, Locke G, Schleck C, Zinsmeister A, Melton L, Talley N. Natural history of functional gastrointestinal disorders: A 12-year longitudinal population-based study. Gastroenterology 2007;133:799-807.
Hungin AP, Whorwell PJ, Tack J, Mearin F. The prevalence, patterns and impact of irritable bowel syndrome: An international survey of 40,000 subjects. Aliment Pharmacol Ther 2003;17:643-50.
Thompson WG, Irvine EJ, Pare P, Ferrazzi S, Rance L. Functional gastrointestinal disorders in Canada:First population-based survey using Rome II criteria with suggestions for improving the questionnaire. Dig Dis Sci 2002;47:225-35.
Wilson S, Roberts L, Roalfe A, Bridge P, Singh S. Prevalence of irritable bowel syndrome: A community survey. Br J Gen Pract 2004;54:495-502.
Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Thompson WG. U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci 1993;38:1569-80.
Jones R, Lydeard S. Irritable bowel syndrome in the general population. BMJ 1992;304:87-90.
Agarwal N, Spiegel BM. The effect of irritable Bowel syndrome on health-related quality of life and health care expenditures. Gastroenterol Clin North Am 2011;40:11-9.
Phillips SF. Foreword. In: Drossman DA, editor. The Functional Gastrointestinal Disorders. Boston New York Toronto London: Little Brown and Co; 1994. p. xiii-xv.
Liu L, Xiao Q, Zhang Y, Yao S. A cross-sectional study of irritable bowel syndrome in nurses in China: Prevalence and associated psychological and lifestyle factors. J Zhejiang Univ Sci B 2014;15:590-7.
Drossman DA, Corazziari E, Delvaux M, Spiller RC, Talley NJ, Thompson WG, et al
. Rome III: The Functional Gastrointestinal Disorders. 3rd
ed. McLean: Degnon Associates; 2006.
Koloski NA, Talley NJ, Boyce PM. Predictors of health care seeking for irritable bowel syndrome and non ulcer dyspepsia: A critical review of the literature on symptoms and psychological factors. Am J Gastroenterol 2001;96:1340-9.
Herschbach P, Henrich G, Von Rad M. Psychological factors in functional gastrointestinal disorders: Characteristics of the disorder or of the illness behavior? Psychosom Med 1999;61:148-53.
Whitehead W, Crowell M, Robinson J, Heller BR, Schuster MM. Effects of stressful life events on bowel symptoms: Subjects with irritable bowel syndrome compared with subjects without bowel dysfunction. Gut 1992;33:825-30.
Mertz H, Naliboff B, Munakata J, Niazi N, Mayer EA. Altered rectal perception is a biological marker of patients with irritable bowel syndrome. Gastroenterology 1995;109:40-52.
Mertz H, Morgan V, Tanner G, Pickens D, Price R, Shyr Y. Regional cerebral activation in irritable bowel syndrome and control subjects with painful and nonpainful rectal distention. Gastroenterology 2000;118:842-8.
Roshandel D, Rezailashkajani M, Shafaee S, Zali MR. Symptom patterns and relative distribution of functional bowel disorders in 1, 023 gastroenterology patients in Iran. Int J Colorectal Dis 2006;21:814-25.
Darweesh M, El Hameed M, Hassan Y, El Rheem K, Mohamed S, Mahdy M, et al
. The prevalence of irritable bowel syndrome among medical and non-medical Suez Canal University students. Open J Gastroenterol 2015;5:42-8.
Mansour-Ghanaei F, Fallah MS, Heidarzadeh A, Jafarshad R, Joukar F, Ghasemipour R, et al
. Prevalence and characteristics of irritable bowel syndrome (IBS) among medical students of Gilan Northern Province of Iran. Middle East J Dig Dis 2011;1:100-5.
Abdulmajeed A, Rabab MA, Sliem HA, Hebatallah NE. Pattern of irritable bowel syndrome and its impact on quality of life in primary health care center attendees, Suez governorate, Egypt. Pan Afr Med J 2011;9:5.
Okami Y, Kato T, Nin G, Harada K, Aoi W, Wada S, et al
. Lifestyle and psychological factors related to irritable bowel syndrome in nursing and medical school students. J Gastroenterol 2011;46:1403-10.
Jimenez C, Navia-Osorio PM, Diaz CV. Stress and health in novice and experienced nursing students. J Adv Nurs 2010;66:442-55.
Khamis Ragab Ibrahim N, Fahad Battarjee W, Ahmed Almehmadi S. Prevalence and predictors of irritable bowel syndrome among medical students and interns in King Abdulaziz University, Jeddah. Libyan J Med 2013;8:21287.
Naeem S, Siddiqui E, Kazi A, Memon AA, Khan ST, Ahmed B. Prevalence and factors associated with irritable bowel syndrome among medical students of Karachi, Pakistan: A cross-sectional study. BMC Res Notes 2012;5:255.
Chu L, Zhou H, Lu B, Chen MY. An epidemiological study of functional bowel disorders in Zhejiang college students and its relationship with psychological factors. Zhonghua Nei Ke Za Zhi 2012;51:429-32.
Jung HJ, Park MI, Moon W, Park SJ, Kim HH, Noh EJ. Are food constituents relevant to the irritable bowel syndrome in young adults? A Rome III based prevalence study of the Korean medical students. J Neurogastroenterol Motil 2011;17:294-9.
Jafri W, Yakoob J, Jafri N, Islam M, Ali QM. Frequency of irritable bowel syndrome in college students. J Ayub Med Coll Abbottabad 2005;17:9-11.
Okeke EN, Ladep NG, Adah S, Bupwatda PW, Agaba EI, Malu AO. Prevalence of irritable bowel syndrome: A community survey in an African population. Ann Afr Med 2009;8:177-80.
] [Full text]
Tan YM, Goh KL, Muhidayah R, Ooi CL, Salem O. Prevalence of irritable bowel syndrome in young adult Malaysians: A survey among medical students. J Gastroenterol Hepatol 2003;18:1412-6.
Husain N, Chaudhry IB, Jafri F, Niaz SK, Tomenson B, Creed F. A population-based study of irritable bowel syndrome in a non-Western population. Neurogastroenterol Motil 2008;20:1022-9.
Hungin A, Chang L, Locke G, Dennis EH, Barghout V. Irritable bowel syndrome in the United States: Prevalence, symptom patterns and impact. Aliment Pharmacol Ther 2005;21:1365-75.
Andrews EB, Eaton SC, Hollis KA, Hopkins JS, Ameen V, Hamm LR. Prevalence and demographics of irritable bowel syndrome: Results from a large web-based survey. Aliment Pharmacol Ther 2005;22:935-42.
Taylor S, Klein L, Lewis B, Gruenewald TL, Gurung RA, Updegraff JA. Biobehavioral responses to stress in females: Tend-and-befriend, not fight-or-flight. Psychol Rev 2000;107:411-29.
Khoshkrood-Mansoori B, Pourhoseingholi MA, Safaee A, Moghimi-Dehkordi B, Sedigh-Tonekaboni B, Pourhoseingholi A. Irritable bowel syndrome: A population based study. J Gastrointest Liver Dis 2009;18:413-8.
Farzaneh N, Ghobaklou M, Moghimi-Dehkordi B, N
Fadai. Effects of demographic factors, body mass index, alcohol drinking and smoking habits on irritable bowel syndrome: A case control study. Ann Med Health Sci Res 2013;3:391-6.
] [Full text]
Nam SY, Byung BC, Ryu KH, Park BJ. Prevalence and risk factors of irritable bowel syndrome in healthy screenee undergoing colonoscopy and laboratory tests. J Neurogastroenterol Motil 2010;16:47-51.
Chirila I, Petrariu FD, Ciortescu I, Mihai C, Drug VL. Diet and irritable bowel syndrome. J Gastrointestin Liver Dis 2012;21:357-62.
Dong YY, Zuo XL, Li CQ, Yu YB, Zhao QJ, Li YQ. Prevalence of irritable bowel syndrome in Chinese college and university students assessed using Rome III criteria. World J Gastroenterol 2010;16:4221-6.
Kim YJ, Ban DJ. Prevalence of irritable bowel syndrome, influence of lifestyle factors and bowel habits in Korean college students. Int J Nurs Stud 2005;42:247-54.
Liu Y, Liu L, Yang Y, He Y, Zhang Y, Wang M, et al
. A school-based study of irritable bowel syndrome in medical students in Beijing, China: Prevalence and some related factors. Gastroent Res Pract 2014;2014:1-8.
Zhou HQ, Yao M, Chen GY, Ding XD, Chen YP, Li DG. Functional gastrointestinal disorders among adolescents with poor sleep: A school-based study in Shanghai, China. Sleep Breath 2012;16:1211-8.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]