Comparing Prevalence of Irritable Bowel Syndrome among Medical Sciences Students in Qassim, Saudi Arabia

Introduction

Irritable bowel syndrome (IBS) is a chronic functional disorder that affects the large intestine 1. IBS affects 10-20% of general population with only 15% seeking medical care 2. In addition, 5% or more of visits to general practitioners and 20-50% of referrals to gastroenterologists are due to IBS related complains 3.

Studies in the general population have reported varying prevalence of IBS 4-6. Similarly, a wide variation in the prevalence of IBS among medical students has been reported. Studies from other countries and Saudi Arabia have reported prevalence of IBS among medical students range from 12.6% to 38% 7-13.

All these studies have focused only on medical students and none of them has compared prevalence across different specialties within medical sciences. Difference in curriculum, stress levels, number of bachelor years and population characteristics associated with each of the specialties may lead to differences in the risk of IBS among students in these fields and hence it may affect the prevalence. This study aimed to estimate and compare the prevalence of irritable bowel syndrome among medical sciences students in Qassim region of Saudi Arabia.

Methods

Study design and population:

This was a cross sectional study among medical colleges (Medical schools, nursing, applied medical sciences, pharmacy, and dentistry colleges) in Qassim region, Saudi Arabia. Medical sciences students (medicine, pharmacy, nursing, applied medical sciences and dentistry students) enrolled in participating institutes.

Sample size:

Sample size was calculated using Open Epi online sample size calculator. The prevalence of IBS among medical students has been reported to be 13.7% in Qassim region in a previous study 11. We used this as expected prevalence for our sample size calculations. At 95% confidence level and 5% margin of error, the calculated sample size was 182. We further applied a design effect of 1.5 to account for non-random sampling. The final sample required was 273 medical sciences students (medicine, pharmacy, nursing, applied medical sciences and dentistry students).

Sampling procedure:

Convenience sampling strategy was used to enroll potential participants. Medical field students currently enrolled in medical, nursing, applied medical sciences, pharmacy and dentistry colleges in Qassim region eligible to participate in the study. We approached batch leaders of different specialties in different years via WhatsApp groups and they helped in disseminating the questionnaire.

Data collection:

Data was collected using a self-administrating questionnaire, distributed online to the potential participants. Questionnaire had two sections. First question had variables related to personal and clinical information i.e. age, gender, marital status, current parents status, Family history of IBS, chronic health problems, food allergies, daily sleeping hours, smoking status, regular exercise, Grade Point Average (GPA), specialty and year of studying. Second section consisted of Rome IV questionnaire for adults. Rome IV questionnaire is a validated tool and has been used in various studies 12, 14.

Data analysis:

Data was downloaded as excel sheet and exported to SPSS version 21.0 for analysis. Variables in Rome IV were coded and sum scores were calculated according to the standard guidelines of the tool. Descriptive analysis was carried out to calculate frequencies and proportions and prevalence of IBS. Chi-square test was used to compare the prevalence among categories of personal and clinical variables. Logistic regression analysis was done to assess the association of IBS with specialty and other factors. Variables with p-value less than 0.2 in the univariate analysis and with biological plausibility regardless of statistical significance were included in the multivariate models. Variables in the final model were retained based on changes in -2log likelihood ratios. Crude and adjusted odds ratio (OR) along with associated 95% confidence intervals (CIs) were calculated.

Ethics:

Study proposal was reviewed and approved by subcommittee of Health Research Ethics, Deanship of Scientific Research, Qassim University. Permission for data collection was sought from the administration of participating institutes. Informed consent was obtained from all the participants. Confidentiality of the participants was maintained at all levels and no personal identifier was obtained.

Results

A total of 271 medical sciences students participated and completed the questionnaire. Socio-demographic characteristics of medical and allied health sciences students are given in table 1. About 14.8% of the respondents had chronic health problems, (35.8%) have positive family history of IBS and (29.9%) enrolled in the college of medicine. About 14.8% of the respondents had chronic health problems, (35.8%) have positive family history of IBS and (29.9%) enrolled in the college of medicine.

We found that the prevalence of IBS was 20.5% among medical field students; 28.4% of medical, 11.5% of pharmacy, 27.1% of dentistry, 31.4% of nursing, 5.5% of applied medical sciences students. In addition, (42.5%) of students with chronic diseases, 29.9% of students with family history of IBS, (33.3%) of smokers students and (16.1%) of students who sleep more than eight hours have been diagnosed with IBS.(31.4%) of nursing students, (28.4%) of students who are enrolled in college of medicine and (17.6%) of interns have been diagnosed with IBS.

Table 3 shows the results of univariate and multivariate logistic regression analyses. In the univariate analysis we found that, chronic health problems, food allergies and family history of IBS, smoking status and specialty were significantly associated with IBS. In the multivariate analyses; chronic health problems adjusted odds ratio (aOR) 3.53 (95% CI: 1.44 – 8.63) and family history of IBS aOR 2.13 (95% CI: 1.07 – 4.24) were significant predictors of IBS. Specialty was found to be significantly associated with the risk of IBS; nursing aOR 11.63 (95% CI: 2.43 – 55.50), dentistry aOR 10.17 (95% CI: 2.26 – 45.84) and medicine aOR 8.20 (95% CI: 1.91 – 35.18).

Discussion

This study is one of the few studies from KSA to assess the burden of IBS and its association with medical sciences specialties. We found that 20.5% of students had IBS. This is more than the reported prevalence of IBS among medical students in Qassim region which was 13.7% 11. Our estimate is also higher than other reported from other regions of Saudi Arabia 15.5% to 18% 9, 12. Prevalence among medical students in our study 28.4% is comparable to a study from Jeddah 31.8% 10 and a national level study which showed prevalence among medical students to be 31.9% 15. Our results are also comparable to estimates from Pakistan, where about 26% - 28% of the medical students were found to have IBS while higher than Iran 12.6% 7, 8, 16. These variations in the studies could be explained partially by the differences in tools used for the assessment of IBS. Other reasons for higher prevalence in our study could be inclusion of different specialties other than medicine in our study.

Although literature suggest that female are at higher risk of IBS than males 17. A study of IBS among medical students in Beijing, China, showed that female students were twice more likely to suffer from IBS than males 18. Some studies from Saudi Arabia have also shown a significant association of female gender with higher risk of IBS 10, 15. Contrary to this, 24.7% of male students and 18.7% of female students had IBS in our study. This difference however was not significant. This finding is similar to other studies on medical students and school teachers in Qassim region 4, 11. Although Saudi females have started to be involved in all work field but males still have more financial responsibility which make them more susceptible to stress. This variation in the association of gender with IBS could also be explained in terms of socio-economic and cultural differences in different regions of Saudi Arabia. In spite of many studies support that exercise 11 and GPA 5 are significantly associated with IBS, in our study we found that there is no significant association of exercise and GPA with IBS.

In this study, 36.6% of students with food allergies have IBS while 17.8% of students without food allergies have IBS. However in the multivariate analysis food allergy was not significantly associated with IBS. This finding is consistent with a study from Jeddah 10.

Although some studies showed no relation between sleep hours and prevalence of IBS, in this study, 25.4% of students who sleep < 8 hours are diagnosed with IBS while only 16.1% of students who sleep > 8 hours are diagnosed with IBS. This however was not significant in the multivariate analysis. Other studies have reported inconsistent relationship of sleep hours and IBS 10, 15. Since genetic factors may play a role in the pathophysiology of IBS, many studies showed that having a positive family history of IBS increases the risk of developing the disease 15, 19. We also found a significant association of family history of IBS with IBS.

Having chronic health problems was found to be significantly associated with IBS in our study. This is similar to a study of prevalence of IBS among medical students conducted in Qassim region, Saudi Arabia 11. On the other hand, studies conducted among medical students and nurses in Jeddah, Saudi Arabia, showed that chronic health problems are not significantly associated with IBS 10.

As expected, students who have their parents divorced or dead (either one or both) have higher prevalence of IBS (26.9%) compared to students whom their parents live together. However this difference was not significant. A finding contrasting other studies from Saudi Arabia where those living away from parents and family were at higher risk of IBS 10, 15. We did not find a significant association of smoking with IBS, a finding similar to other study on medical students in Jeddah 10.

In this study we found a significant association of specialty with the risk of IBS. Compared to applied health sciences, those in nursing, dentistry and medicine were at higher risks of IBS. A study among undergraduate students in Saudi Arabia also showed that those in the medical field are about seven times higher risk of IBS than non-medical 15. Stress is a very well known risk factors of IBS 10, 19. Those in the medical and nursing field may be exposed a higher levels of stress and anxiety because of their curriculum and requirements 16. This is an important finding with implication for policy makers and institutions to establish students help desks and provide counselling services to address anxiety and stress that may affect them.

Strengths and Limitation:

This study is one of few attempts to measure the burden of IBS among medical field students and assess the association of IBS with specialty. We used a validated tool for the assessment of IBS. However there are certain methodological limitations which need to be considered while interpreting the results of this study. Firstly, data was collected online due to which response rate cannot be ascertained as it was not possible to assure how many students received the questionnaire link. Secondly, proportion of nursing students was disproportionately low, compare to others. We powered our sample for the prevalence only. Sample may not be powered enough for some of the associations observed in this study.

Conclusion:

The prevalence of IBS in medical field students was found to be high. Students in the nursing, medicine and dentistry are at higher risk of having IBS. This calls the academic staff and decision makers to address this problem by developing strategies for prevention, detection, and treatment of IBS. Regular screening based on the risk factors of the medical sciences students may help detect disorder early and help them maintain functionality.

Given the diversity of medical sciences fields, their curriculum and institutions, we also recommend large scale studies to validate the finding of our study. Such studies should utilize a uniform methodology and tool across disciplines and institutions to obtain comparable results for decision making.

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