Irritable Bowel Syndrome Prevalence, Types and Associated Depressive Symptoms in Riyadh Region, KSA
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The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (2), Page 3924-3929
Irritable Bowel Syndrome Prevalence, Types and Associated Depressive
Symptoms in Riyadh Region, KSA
Abdulrahman Ibrahim S Almousa1, Atheer Mohammed D Alotaibi 2
1 Prince Sattam bin Abdulaziz University, Akharj, 2 Almaarefa Colleges for science and Technology,
College of Medicine, Riyadh, Saudi Arabia
ABSTRACT
Background: The relationship between psychiatric disorders and GI disorders such as IBS is well established.
IBS patients typically suffer from depressive symptoms, which can aggravate their IBS symptoms. Objective: to
quantify the prevalence of IBS and its association with depressive symptoms among the Riyadh general
population.
Methods: This cross-sectional study was conducted on Riyadh general population. The study included Saudi
citizens, age was above 18 years old. Data were collected through personal interviews. Two self-administered and
validated questionnaires were used. The first questionnaire is the Rome III criteria; a system developed to classify
functional GI disorders (FGIDs), which are disorders of the digestive system for which clinical symptoms cannot
be explained by the presence of structural or tissue abnormalities, the second questionnaire is the Patient Health
Questionnaire (PHQ-9), a set of three self-report scales designed to measure the Major depressive disorder.
Results: The prevalence of IBS, was 17.3%. 71.3% of cases had mixed (constipation and diarrhea) type, 5.3%
had diarrhea predominant type and 23.4% had constipation predominant IBS. Most (73.4%) of the IBS cases were
females. Among IBS cases, 20.2% had minimal depressive symptoms, 20.2% had major depression, mild
severity. Major depression with moderate severity was found in 18.1% and major depression with severe severity
was found in 28.7%. Family History of crohn's disease and stomach cancer were found in 17.0% and 92.6% of
IBS cases respectively. Conclusion: A high prevalence of depression symptoms in our subjects emphasize the
importance of the psychological evaluation of the patients with IBS, in order to better management of the patients
and may also help to reduce the burden of health care costs.
Keywords: Anxiety, depression, distress, irritable bowel syndrome, psychiatric problem.
INTRODUCTION
Irritable bowel syndrome (IBS) is a functional GI motility of intestine, visceral hypersensitivity,
disorder characterized by abdominal pain and altered inflammation, neurotransmitter imbalance,
bowel habits in the absence of specific and unique disturbance of brain-gut interaction, abnormal
organic pathology. The diagnosis of IBS is based on central processing, autonomic and hormonal events,
clinical findings and the exclusion of other disorder and genetic, environmental, and psychosocial factors
[1]
. Irritable bowel syndrome (IBS) is one of the most may contribute to incidence of IBS [6].
frequently diagnosed gastrointestinal (GI) disorders IBS has strong negative effect on quality of life in
in primary care and gastroenterology practices, patients who suffer from it, and it imposes
despite the fact that many suffer symptoms without substantial social and economic costs due to medical
knowing their diagnosis or seek for medical consult seeking behavior and absenteeism [7].
[2]
. Patient of IBS may complain of variety of Several studies have evaluated the relation
intestinal symptoms such as abdominal pain, between IBS and psychiatric disorders [8]. It has
disturbed defecation (urgency, straining, incomplete been reported that neurosis, anxiety, depression and
evacuation, altered stool form and frequency) and dysfunctional cognition are more prevalent in
bloatedness, and extra intestinal symptoms such as patients with IBS [9].In a large randomized controlled
Nocturia, frequency and urgency of micturition, trial found that 44% of IBS patients had psychiatric
incomplete bladder emptying, back pain, an co-morbidity which depressive and anxiety disorders
unpleasant taste in the mouth, a constant feeling of were the most common conditions [10].
tiredness and in women dyspareunia which has Depression in patients with IBS is more severe
strong impact on patient’s psychological state [3]. and prevalent than in healthy individuals [11].
The worldwide prevalence of IBS ranges from In a study conducted in Arar, Northern KSA, to
5.7% to 34% [4]. It usually varying significantly determine the prevalence of IBS among Educated
between countries according to the diagnostic and Working Women, it was found that, the overall
criteria used [5]. prevalence of IBS was 35.7% [12].
Despite the high prevalence of IBS in general In a study carried out in Iran to show the
population and the personal and economic costs, its prevalence of IBS among adults aged 19-70 years.
etiology remains unknown; however, various studies The overall prevalence of IBS was 21.5%, it was
have shown that several factors including abnormal more prevalent in women than men (24.0 vs. 18.3%)
3924
Received: 16/04 /2018
Accepted: 25/04/2018
Irritable Bowel Syndrome Prevalence…
[13]
. Another study was conducted in Egypt by 17.3% in addition, 44.2% of the studied population
Ahmed et al. [14] in an urban area in Suez were suspicious of IBS. Concerning the types of
governorate, Rome II criteria were used for the IBS, 71.3% of cases had mixed (constipation and
diagnosis of IBS. The prevalence of IBS among the diarrhea) type, 5.3% had diarrhea predominant type
study sample was 34.2%. Notably, up to our and 23.4% had constipation predominant IBS.
knowledge, there is a lack of studies on this specific (Table 1). Table (2) illustrates the relation between
topic in Riyadh region, central Saudi Arabia in IBS and sex, age, region of the studied population.
particular. Hence this study was conducted among Most (73.4%) of the IBS cases were females, 48.9%
the Riyadh general population to quantify the of cases aged 15 to 30 years and 55.3% from the
prevalence of IBS and its association with depressive middle region. Table (3) shows the relation between
symptoms. IBS and depressive symptoms. We found that,
among IBS cases, 20.2% had minimal depressive
PARTICIPANTS AND METHODS
symptoms, 20.2% had Major depression, mild
This cross-sectional study was conducted on
severity. Major depression with moderate severity
Riyadh general population during the 2016-2017
was observed in 18.1% and major depression with
years. The study included Saudi citizens age above
severe severity was found in 28.7%. We found that
18, those who are under 18 years old were excluded.
66.0% of IBS cases receive medications, compared
The sample size was calculated using the sample
to 41.3% of normal population. Family History of
size equation: n=z2p(1-p)/e2, considering target
crohn's disease was found in 92.6% of IBS cases
population more than 1000, and study power 95%.
and in 93.4% of normal population. Family History
Systematic random sampling technique was
of milk allergy, coeliac disease and stomach cancer
followed. After identifying the first house randomly
were found in 16.0%, 1.1% and 17.0% of IBS cases
in the selected area, every 9th house was visited to
respectively, while they were found in 11.9%, 0.7%
include all the adult subjects residing in those
and 7.5% of normal population respectively. In
selected houses till the required sample is covered.
comparing family history of stomach cancer among
Data was collected through personal interviews
IBS cases and normal population P value was
with the sampled population and filling the
significant (0.005), (Table 4).
questionnaires. Two self-administered and validated
questionnaires were used. The first questionnaire is Table (1): Sex, age, region of the studied
the Rome III criteria, a system developed to classify population, prevalence and types of Irritable Bowel
functional GI disorders (FGIDs), which are disorders Syndrome in Riyadh region, KSA, 2018 (N=548)
of the digestive system for which clinical symptoms Sex Frequency Percent
cannot be explained by the presence of structural or Female 369 67.3
tissue abnormalities [15]. The second questionnaire Male 179 32.7
was the Patient Health Questionnaire (PHQ-9) [16], a Age
set of three self-report scales designed to measure Abdulrahman Almousa and Atheer Alotaibi
Figure (1): Irritable Bowel Syndrome among Riyadh Population,
KSA, 2018
44.2% 17.2%
38.7%
Positive Negative Suspicious
Figure (2): Types of Irritable Bowel Syndrome in Riyadh , KSA,
2018
22%
5.0%
67%
Constipation type Diarrhea type Mixed
3926Irritable Bowel Syndrome Prevalence…
Table (2): Relation between IBS and sex, age, region of the studied population, Riyadh, 2018
Variable IBS Total (n=548) P value
Yes (n=94) No (n=454)
Sex
Female 69 300 369 0.103
73.4% 66.1% 67.3%
Male 25 154 179
26.6% 33.9% 32.7%
Age
Abdulrahman Almousa and Atheer Alotaibi
Table (4): Relation between IBS and Taking medications, family History of crohn's disease, milk allergy,
coeliac disease and stomach cancer among the studied population, Riyadh, 2018
Variables IBS Total P value
Yes (n=94) No (n=454) (n=548)
Taking medications
Yes 62 187 249 0.000
66.0% 41.2% 45.4%
No 32 267 299
34.0% 58.8% 54.6%
Family History of chron's disease
Yes 87 424 511 0.455
92.6% 93.4% 93.2%
No 7 30 37
7.4% 6.6% 6.8%
Family History of milk allergy
Yes 15 54 69 0.180
16.0% 11.9% 12.6%
No 79 400 479
84.0% 88.1% 87.4%
Family History of coeliac disease
Yes 1 3 4 0.530
1.1% .7% .7%
No 93 451 544
98.9% 99.3% 99.3%
Family History of stomach cancer
Yes 16 34 50 0.005
17.0% 7.5% 9.1%
No 78 420 498
83.0% 92.5% 90.9%
DISCUSSION mixed IBS type, 5.3% had Diarrhea IBS type and
The relationship between psychiatric disorders 23.4% had constipation predominant IBS which is
and GI disorders such as IBS is well established. inconsistent with the findings of a study done among
IBS patients typically suffer from anxiety and Japanese university students by Shiotani A et al. [19]
depression, which can aggravate their IBS symptoms who showed that the constipation predominant type
[3]
. This was a cross-sectional study, conducted on was more prevalent (47.8%). However, conclusion
the Riyadh general population to quantify the of the present study is in agreement with those
prevalence of IBS and its association with depressive remarked by Naeem et al. [18] where the most
symptoms. common type was the mixed IBS type followed by
In this study the prevalence of IBS was 17.2% constipation predominant IBS students and interns at
which is in line with the finding of Hungin et al. King Abdulaziz University, Jeddah by Ibrahim et
[17]
. Who conducted an international study among al.[5] The type of IBS was constipation type in 22%
41,984 individuals across eight European countries of our participants, diarrhea type in 5% and mixed in
and found that the prevalence of IBS was 11.5%. 67%. In this study, IBS cases were 73.4% females
The prevalence of IBS was higher compared to and 26.6% males but no significant difference
the findings of a cross-sectional study conducted in between males and females (P= 0.103). Our results
Suez governorate, Egypt, and found that the agreed with those of Nam S et al. [20] in their study
prevalence of IBS among the studied population was in Korea.
34.2% [14] and the results of a study carried out in Also in a study done by Alaqeel M et al. [21];
Karachi, Pakistan by Naeem et al. [18] where the their results demonstrated that IBS was more
prevalence of IBS was 28.3%. The present results prevalent among females.
revealed that 71.3% of the diseased students had a In the present study, we found a significant
correlation between age and IBS (P= 0.013). Also
3928Irritable Bowel Syndrome Prevalence…
the results indicated a highly significant correlation Population-based survey using the Rome II criteria. J
between depressive symptoms and IBS (p= 0.000). Gastroenterol Hepatol., 21:1687–92.
8. Koloski NA, Talley NJ, Boyce PM (2003): Does psychological
A high number of our positive IBS participants distress modulate functional gastrointestinal symptoms and
(46 over 94 participants) were in the age between 15 health care seeking? A prospective, community Cohort
to 30 years and the number gets lesser with advanced study. Am J Gastroenterol., 98:789–97.
age. This inverse relationship between age and IBS 9. Gonsalkorale W, Perrey C, Pravica V, Whorwell PJ,
Hutchinson IV (2003): Interleukin 10 genotypes in irritable
was also reported in the work done by Nam S et al. bowel syndrome: Evidence for an inflammatory
[20]
. The majority of positive IBS participants in our component? Gut, 52:91–3.
study were having a depressive symptoms varying 10. Guthrie E, Creed F, Fernandes L, Ratcliffe J, Van Der Jagt
between mild to severe. In the study carried by J, Martin J et al. (2003): Cluster analysis of symptoms and
Ibrahim N et al. [5], they found that participants health seeking behaviour differentiates subgroups of patients
with severe irritable bowel syndrome. Gut, 52:1616–22.
with morbid depression had a higher prevalence 11. Talley NJ (2008): Functional gastrointestinal disorders as a
(41.9%) of IBS compared to those with borderline public health problem. Neurogastroenterol Motil., 20:121–9.
depression (29.5%) or normal participants (31.5%). 12. Alshammari M, ALshamari N, Alshammari A et al. (2016):
Another study done in Japan [22] showed that Irritable bowel syndrome among employed women in Arar city,
Northern Saudi Arabia. Int. J. Adv. Res., 4(10), 1539-1544.
individuals with IBS had higher scores on the 13. Keshteli A, Dehestani B, Daghaghzadeh H, and Adibi P
Hospital Anxiety and Depression Scale (HADS) (2015): Epidemiological features of irritable bowel syndrome
compared to control subjects. Also Tan et al. [23], and its subtypes among Iranian adults. Ann Gastroenterol.,
reported that 24.4% of students complaining of IBS 28(2): 253–258.
have depression symptoms. The Logistic regression 14. Ahmed A., Mohamed R, Sliem H and Nour Eldein N (2011):
Pattern of Irritable Bowel Syndrome and Its Impact on Quality
analysis in Gómez's [24] also showed an association of Life in Primary Health Care Center Attendees, Suez
with depressive symptoms and female sex Governorate, Egypt. Pan Afr Med J., 9: 5.
independently of age and depression and anxiety 15. Rome Foundation(2015): Rome III Disorders and
symptoms. Another study conducted by Kurland Criteria. Available from: http://www.romecriteria.org/criteria/.
16. Kroenke K, Spitzer RL, Williams JB(2001): The PHQ-9:
JE et al. [25] found similar results. The association validity of a brief depression severity measure. J Gen Intern
between psychological disorders (including Med.,16(9):606-13.
depression) and functional bowel disorders is well 17. Hungin AP, Whorwell PJ, Tack J, Mearin F(2003): The
established. prevalence, patterns and impact of irritable bowel syndrome: an
international survey of 40,000 subjects. Aliment Pharmacol
Ther., 17:643–50.
CONCLUSION 18. Naeem S, Siddiqui E, Kazi A, Memon A , Khan T and
The high prevalence of depression symptoms Ahmed B (2012): Prevalence and Factors Associated with
observed on our subjects emphasize the importance Irritable Bowel Syndrome among Medical Students of Karachi,
of the psychological evaluation of the patients with Pakistan: A Cross-Sectional Study. BMC Research Notes, 5,
255.
IBS, in order to better management and deal with 19. Shiotani A, Miyanishi T, Takahashi T et al. (2006): Sex
the patients which could help in minimizing the Differences in Irritable Bowel Syndrome in Japanese University
burden of health care costs. Students, Japan. Journal of Gastroenterology, 41, 562-568.
20. Nam SY, Kim BC, Ryu KH, and Park BJ (2010): Prevalence
REFERENCES and Risk Factors of Irritable Bowel Syndrome in Healthy
Screenee Undergoing Colonoscopy and Laboratory Tests. J
1. Jafri W, Yakoob J, Jafri N, Islam M and Ali Q (2005):
Neurogastroenterol Motil., 16(1): 47–51.
Frequency of Irritable Bowel Syndrome in College Students.
Journal of Ayub Medical College Abbottabad, 17(4):9-11. 21. Alaqeel MK, Alowaimer NA, Alonezan AF, Almegbel
NY, Alaujan FY (2017): Prevalence of Irritable Bowel
2. Occhipinti K and Smith J (2012): Irritable Bowel Syndrome:
Syndrome and its Association with Anxiety among Medical
A Review and Update. Clinics in Colon and Rectal. Surgery, 25,
Students at King Saud bin Abdulaziz University for Health
46-52.
Sciences in Riyadh. Pak J Med Sci., 33(1): 33–36.
3. Whorwell P, McCallum M, Creed F, Roberts C (1986): Non-
colonic features of irritable bowel syndrome. Gut, 27:37-40. 22. Okami Y, Kato T, Nin G, Harada K, Wada S, Tsuji T et al.
(2011): Lifestyle and psychological factors related to irritable
4. Shen L, Kong H, Hou X (2009): Prevalence of irritable bowel
bowel syndrome in nursing and medical school students. J
syndrome and its relationship with psychological stress status in
Gastroenterol., 46(12):1403–1410.
Chinese university students. J Gastroenterol Hepatol., 24:1885–
1890. 23. Tan YM, Goh KL, Muhidayah R, Ooi CL, Salem O (2003):
Prevalence of irritable bowel syndrome in young adult
5. Ibrahim N, Battarjee W, Almahdi S et al. (2013): Prevalence
Malaysians: a survey among medical students. J Gastroenterol
and Predictors of Irritable Bowel Syndrome among Medical
Hepatol., 18:1412–6.
Students and Interns in King Abdul-Aziz University, Jeddah,
24. Gómez A, Morales V, Rojas M et al.(2009): Prevalence of
Saudi Arabia. Libyan Journal of Medicine, 8, 21287.
irritable bowel syndrome and associated factors according to the
6. Cremonini F, Talley N (2005): Irritable bowel syndrome:
Rome III diagnostic criteria in a general population in Colombia.
Epidemiology, natural history, health care seeking and emerging
Gastroenterol Hepatol., 32(6):395-400.
risk factors. Gastroenterol Clin North Am., 34:189-204.
25. Kurland J, Coyle W, Winkler A, Zable E (2006): Prevalence
7. Han SH, Lee OY, Bae SC, Lee SH, Chang YK, Yang SY, et
of irritable bowel syndrome and depression in fibromyalgia. Dig
al. (2006): Prevalence of irritable bowel syndrome in Korea:
Dis Sci., 51(3):454-60.
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