The irritable bowel syndrome among adults in Qatif, Saudi Arabia: prevalence and impact on health-related quality of life, by gender and age

Introduction

Irritable bowel syndrome (IBS) is the most frequently diagnosed digestive disorder.¹ It is a symptom-based condition characterized by abdominal pain or discomfort and altered bowel habits in the absence of another disease causing these symptoms.¹ IBS is one of the most prevalent disorders of gut-brain interactions (previously referred to as functional gastrointestinal disorders).² Moreover, it is estimated to affect approximately one in ten people worldwide.² Global prevalence estimates for IBS range widely from 5.7% to 34.0%, depending on the methodology utilized.³ IBS is more common in Westerners (between 10% and 15%) than in Asians (1% to 10%).⁴

Subsequently, it affects 3.8% of people worldwide, and costs €8 billion in Europe and $10 billion in the US in direct and indirect healthcare costs.⁵ IBS is a prevalent disorder that has a significant impact on quality of life and accounts for a significant proportion of healthcare costs.⁶ IBS has a significant impact on the individual's health-related quality of life (HRQoL) and incurs significant costs, both in terms of healthcare delivery and in terms of the economy and society.² Psychological comorbidities and extraintestinal somatic symptom reporting are common in IBS patients, lowering the quality of life, productivity, health impairment, and healthcare utilization.⁵ 11% is the global prevalence of irritable bowel syndrome (IBS), according to a systematic review and meta-analysis, but this varies considerably depending on geographic region, diagnostic criteria used to define IBS, minimum symptom duration required, age, and gender.³ About half to two-thirds of people with IBS have significant psychological or social issues.⁷ Female and male IBS patients differ in symptomatology, comorbidity with other chronic pain syndromes and psychiatric disorders, and serotonergic medication efficacy, highlighting the need for gender-specific treatment.⁸ Psychological interventions are associated with an improvement in HRQoL in all domains.⁹ Populations in Arab countries have received comparatively less research attention. No research from any Arab country was included in a recent meta-analysis of the global prevalence of IBS.³ IBS prevalence data from Saudi Arabia and other Middle Eastern nations is limited. Nevertheless, to the best of our knowledge, no study has examined the effects of IBS on health-related quality of life in Saudis based on gender or age. The purpose of this research is to assess the effects of IBS on patients' quality of life based on age and gender among Saudi adults in Qatif, Saudi Arabia.

Methods

Results

Demographic characteristics of irritable bowel syndrome (IBS)

A total of 279 respondents completed the online questionnaire (response rate:69.75%). The mean age in the sample of eligible respondents was 38.38 years old (SD = 12.62 years, range 18-76 years old). Most of the sample was female (N=157, 56.3%), young adults (N=143, 51.3%, range 18-39 years old), had bachelor's degrees (N=183, 65.6%), were employed (N=167, 59.9%), and had monthly income ($1500 - $5,000) (N=149, 53.4%). Most participants with IBS were female (N=32, 20.4%), middle-aged (N=23, 19.2%, range 40-59 years old), and had a bachelor's degree (N=39, 21.3%). (Table 1). IBS was found to be prevalent in 17.6% of participants, with a higher rate of prevalence among older adults 31.3%, and more in women 20.4% (Figure 1).

Table 1. Demographics characteristics by IBS, N= 279.

		Irritable bowel syndrome (IBS) status
		No		Yes		Total
		N	(%)	N	(%)	N	(%)
Gender	Male	105	(86.1)	17	(13.9)	122	(43.7)
	Female	125	(79.6)	32	(20.4)	157	(56.3)
Age	Young adults (18-39)	122	(85.3)	21	(14.7)	143	(51.3)
	Middle-aged adults (40-59)	97	(80.8)	23	(19.2)	120	(43.0)
	Old adults (above 59)	11	(68.8)	5	(31.3)	16	(5.7)
Educational Level	Under secondary	9	(90.0)	1	(10.0)	10	(3.6)
	Secondary	56	(88.9)	7	(11.1)	63	(22.6)
	Bachelor	144	(78.7)	39	(21.3)	183	(65.6)
	Postgraduate	21	(91.3)	2	(8.7)	23	(8.2)
Job Status	Student	37	(86.0)	6	(14.0)	43	(15.4)
	Employee	137	(82.0)	30	(18.0)	167	(59.9)
	Unemployed	56	(81.2)	13	(18.8)	69	(24.7)
Monthly Income	Less than $1499	57	(82.6)	12	(17.4)	69	(24.7)
	$1500 - $5,000	122	(81.9)	27	(18.1)	149	(53.4)
	More than $5,000	51	(83.6)	10	(16.4)	61	(21.9)

Figure 1. Prevalence of Irritable bowel syndrome (IBS) among Saudis adults public.

Mean of total health-related quality of life (HRQoL), physical component summary (PCS), and mental component summary (MCS)

Overall, the total HRQoL, MCS, and PCS were (42.8, 47.5, and 38.1, respectively). In contrast, overall HRQoL, MCS, and PCS scores for responders with IBS were (38.4, 41.4, and 35.4, respectively) (Figure 2).

Figure 2. Mean score of total HRQoL, PCS, and MCS among Saudi adults and IBS.

Discussion

To the best of our knowledge, this is the first study among Saudi adults in Qatif to use the SF-36, a dependable and valid instrument, to evaluate the impact of irritable bowel syndrome (IBS) on patients' quality of life depending on age and gender among Saudi adults. IBS impacts physical, emotional, and social functioning without causing mortality.¹¹ HRQOL and age/gender in IBS patients are poorly studied. This paper seeks to evaluate the influence of IBS on the quality of life of Saudi adults in Qatif, Saudi Arabia.

Our study found that the prevalence of IBS among Saudi adults is 17.6%, which is lower than that found in a 2019 Saudi national study,¹² which is consistent with previous local studies,^13–15 and approximately 10-20% of adults globally,^16,17 and more than the global IBS prevalence of 3,8%.¹ In our study, females were two times more likely to get IBS in the Saudi population (OR=2.067, 95% CI: 1.017-4.199). Consistent with previous research,³ the current study found that the women-to-men IBS prevalence ratio was 1.5:1. Several studies from the West and Saudi Arabia show that women suffer from IBS at a higher rate than men.^18–20 In contrast, numerous Asian-based studies have found no gender differences in the prevalence of IBS.²⁰ This result is inconsistent with the findings of a prior systematic review and meta-analysis that included 56 studies and 1,88,229 potential participants²¹ and is incompatible with the Saudi study.¹² The explanations are given for sex differences in physiological factors such as gastrointestinal transit time, visceral sensitivity, central nervous system pain processing, and specific effects of sex hormones on gut function. Further factors such as sex differences in stress reactivity, neuroendocrine, and autonomic nervous system may play a role.¹⁸ In addition, investigations carried out in Asian nations like India²² and Taiwan²³ have indicated a higher male or equal gender prevalence of IBS. These gender discrepancies might be partially explained by cultural influences as well as the technique of the study.

According to our findings, we found a statistically significant association between age and IBS. People who were old-aged adults were four times significantly associated with IBS in the Saudi public (OR=4.235, 95% CI: 1.201-14.938). This result is inconsistent with the findings of a previous meta-analysis that did not find a statistically significant association between age and IBS³ and is inconsistent with the Saudi study.¹² Most of the IBS prevalence in the present study were old adults participants, between the ages of 60 and 80, which is inconsistent with the reported literature,^24,25 but consisted of systematic national health surveys data from six large studies including (4.7 million people) conducted in the United States.²⁶

This study indicates conclusively that participants with IBS had a significantly poorer HRQoL than non-IBS based on age and gender. The participants with IBS in this study had poorer physical health functioning than the general population in Saudi Arabia. From these data, it is unclear whether psychological factors or physical causes contribute more to the gastrointestinal distress experienced by people with IBS. Recently, the IBS severity score was a strong negative correlation with HRQoL.²⁷ Several studies have shown that people with IBS have considerably lower SF-36 scores than the entire US population, healthy Europeans, and healthy US college students.^28–30 People who suffer from IBS have a lower HRQoL experience than the general population as a whole.⁹ As compared to healthy members of the Saudi population, those with IBS were found to have significantly lower HRQoL than those without the condition as measured with the short-scale SF-36 (P < 0.05). Hahn et al.³¹ discovered that the general health condition of IBS patients in the United Kingdom and the United States was significantly worse than that of the general populations in both countries.

Using a web-based survey methodology to collect data has several strengths: 1) The information was taken from a representative sample of the inhabitants of the city of Qatif in eastern Saudi Arabia. 2) the data was gathered quickly. This study had several limitations: 1) Participants first took part in an online survey study from one city only, so we cannot generalize to all Saudis. 2) Most problem with the web-based method is that you can't get too much clinical data. 3) In addition, there is a possibility of bias if certain individuals do not engage in an online panel owing to technological difficulties. 4) Due to the cross-sectional nature of this study, it is impossible to establish a cause-and-effect relationship. 5) In addition, the data for this study came from self-administered questionnaires, which are inherently subjective and, as a result, have the potential to result in some bias. 6) IBS is an episodic disorder with symptoms that may vary over time, sampling patients at a particular time point is a possible limitation of this and other study methodologies. We recommend conducting an expanded Saudi national study that includes all regions of Saudi Arabia, and we also recommend using the Rome III questionnaire for the diagnosis of IBS. Finally, future research is required to establish a causal relationship between IBS and mental and physical variables, comorbidities, and HRQoL.

Conclusions

Irritable bowel syndrome (IBS) is more prevalent in elderly adults (17.3%), and it is associated with gender and age; women have twice the risk, and the elderly have four times the risk. Furthermore, this study demonstrates that IBS has a negative impact on Health-related quality of life (HRQoL), decreasing it by 30% overall and almost 41% in the Physical component score (PCS). The HRQoL of people who suffer from IBS can be enhanced by looking beyond age and gender.

Author contributions

Conceptualization, A.H.A.A; methodology, A.H.A.A; software, A.H.A.A; validation, A.H.A.A; formal analysis, A.H.A.A; investigation, A.H.A.A, M.S.H.A., M.A.O.A., F.M.A.A., H.M.S.A., A.A.A.A., A.J.Q.A., K.J.A.A., A.H.M.A., H.T.A.A., A.T.T.B., K.A.S.A., H.A.H.A., and A.A.D.A.; resources, A.H.A.A; data curation, A.H.A.A; writing—original draft preparation, A.H.A.A; writing—review and editing, A.H.A.A; visualization, A.H.A.A; supervision, F.A.M.A., and A.H.A.A; project administration, A.H.A.A; All authors have read and agreed to the published version of the manuscript.