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Original Research (Original Article) 


Abdul Sattar Khan et al, 2019;3(1):030–035.

International Journal of Medicine in Developing Countries

Assessment of knowledge and related risk factors of irritable bowel syndrome in Alahsa, Saudi Arabia

Abdul Sattar Khan1, Hassan Ali Al Sayegh2*, Mustafa Mohammed Al Ali2, Abdulaziz Adel Al Qurini2, Hassan Fahmi AlKhars2, Ali Ahmed AlKhars3

Correspondence to: Hassan Ali AlSayegh

*King Faisal University, College of Medicine, Alahsa, Saudi Arabia.

Email: Has.alsayegh [at] gmail.com

Full list of author information is available at the end of the article.

Received: 29 November 2018 | Accepted: 20 December 2018


ABSTRACT

Background:

Irritable bowel syndrome (IBS) is one of the most common causes of gastroenterology clinic referral. IBS patients usually complain of abdominal pain which is associated with defecation or a change in bowel habit. It causes significant impact on quality of life and results in functional disabilities. The prevalence of IBS in Saudi Arabia was found to be about 40%. This study was done to assess the knowledge and beliefs regarding IBS among AlAhsa population, Saudi Arabia.


Methodology:

Questionnaire was distributed electronically in conjugation with individual interviews. Questions regarding IBS knowledge and beliefs were asked. It was conducted in Alahsa during May 2018 to June 2018.


Results:

The result of 325 randomly selected participants was included, 54.2% were males and 45.8% were females. Their age ranged from 18 years to more than 65 years. Most of the questions were answered correctly. IBS was more prevalent in young adults. Attitude and beliefs regarding IBS also showed the acceptable rate of correct answers. Nearly, 51.8% of the participants thought surgery could alleviate the symptoms of IBS.


Conclusion:

There should be programs regarding IBS awareness to increase the knowledge and decrease functional disabilities and impact on life.


Keywords:

Alahsa, irritable bowel syndrome, knowledge.

Introduction

The cause of irritable bowel syndrome (IBS) is still not obvious but multiple factors play role in this disease. Studies have shown that patients with IBS are more likely to have symptoms of psychological distress [18]. IBS is one of the most prevalent functional gastrointestinal disorders worldwide observed in the general population. Also, it is one of the most common disorders that are seen in USA by gastroenterologists [8]. It consists of a group of functional bowel disorders in which abdominal discomfort or pain is associated with defecation or a change in bowel habit, and with features of disordered defecation [9]. Irritable bowel syndrome (IBS) is one of the most common causes of gastroenterology clinics referral. The characteristics of this disease are abdominal pain, constipation, diarrhea, or a combination of both constipation and diarrhea, mucus discharge in conjunction with stools and changes within the form (appearance) of stools. No specific investigation can identify this disease [10]. Instead, the diagnosis is based on the exclusion of other diseases and specific symptoms guided by Rome Criteria [11,12].

The prevalence of IBS in Asia varies between 3.5% and 25% according to the studies that have been reported [13]. In developing countries such as Turkey and Pakistan the prevalence rates were 14% and 10%, respectively [14,15]. A study included 2,025 secondary school males’ students in Al Jouf area, Saudi Arabia, the prevalence of IBS was 8.9% and 9.2% [16]. Prevalence is relatively higher in younger adults than other age groups [17]. The condition is troublesome and costly and should be considered because it is associated with more economic burden on the health care system. The patients with IBS have higher resources utilization of the healthcare system than other patients in terms of increased rates of unnecessary surgery, more tests, greater medication use and frequent physician visits [18,19]. Another study included 300 school teachers in Qassim region, Saudi Arabia, which used a self-administered questionnaire. The prevalence of IBS symptoms among teachers was 40.7% with no significant gender predilection [20]. Nearly, all the studies conducted in Saudi Arabia concluded that female patients are commonly affected by IBS [21]. IBS is a widespread functional disorder in Western countries but there is less information about its prevalence in Saudi Arabia. In addition, information on the precipitating factors, prevalence, and the associated factors. The present study aimed at determining the knowledge and attitude of IBS among AlAhsa population, Saudi Arabia.

Materials and Methods

A cross-sectional survey was conducted. One part covered demographic characteristics of the participants and the other part focused the domain of patient knowledge. Within the domain of patient’s attitudes and knowledge about IBS, the survey addressed the most important information about IBS. Score 1 was given to correct answers and the mean and median were calculated on the basis of which a cutoff point was made to decide about poor and good knowledge. Those who scored above the median were considered to have good knowledge.

The questionnaire was used previously in two studies and have been reported and validated [22,23]. Then, analysis categorized the answers according to the level of knowledge. Questionnaire was distributed electronically, and interviews were conducted from the general population of AlAhsa after a verbal consent. All age groups from both genders were included randomly. Excluded from the sampling frame were individuals with severe cognitive impairment (e.g., mental retardation). Scoring system was divided into three categories: 0% to 30% represented poor knowledge, 31% to 70% represented acceptable level of knowledge, and 71% or above represented excellent level of knowledge. The research had been approved by the committee of Research & Ethics in College of Medicine, King Faisal University. It was conducted in Alahsa from May 2018 to June 2018.

Data were analyzed by using SPSS 20. The main statistical analysis involved using descriptive statistics to compare predictors of knowledge. Responses to survey questions were tabulated according to demographical data. Responses were self-reported and were not verified separately. Differences between groups were calculated with the use of standard confidence intervals. Statistical significance was determined by Fisher Z test. The margin of error was calculated at ±3%. Chi-square test was used for categorical variables, and student’s t-test or rank-sum for continuous variables. A p-value of less than 0.05 was considered significant.

Results

Of the 325 participants included in the study, 54.2% were males and 45.8% were females. Their age ranged from less than 18 years to more than 65 years. A significant group (35.4%) was between 18 and 24 years of age. The majority of the participants (69.5%) had a college degree, 23.7% had a secondary school degree, and 4.9% and a minority of them (1.8%) had a primary school level of education. More than a half (55.4%) of the participants were married, while 43.3% of them were single (Table 1).

The majority of the participants (78.2%) answered that IBS leaves an impact in quality of life and 47.7% thought it cannot shorten the lifespan. About 47.7% thought correctly that IBS is less common than diabetes and hypertension and more than a half (58.8%) thought correctly that IBS is more common than colon cancer. About 86.8% had a good knowledge of risk factors regarding food allergy and nutrition, while 58.5% of participants had a good knowledge about IBS association with genetics and infections. Most of the participants (89.8%) answered correctly about the association of increased IBS symptoms with stresses. The majority of the participants (91.4%) had a good awareness about IBS symptoms. However, more than a half (53.5%) thought that a diagnosis of IBS requires investigations. The results are presented in Table 2.

The majority of the participants had a positive attitude toward changing diet (91.1%), prescribed medications (79.7%), and psychological counseling (74.8%) as all these could improve IBS symptoms. On the other hand, most of the participants had a negative attitude toward unprescribed drugs (44.6%), herbals (40%), and surgical interventions (57.8%) as they do not improve IBS symptoms (Table 3).

Table 1. Demographics of the participants.

Demographical data Frequency
(n = 325)
Percentage %
Gender
Male 176 54.2
Female 149 45.8
Age
18–44 years 242 74.5
45–64 years 69 21.2
Less than 18 and more than 65 years 14 4.3
Social status
Single 141 43.4
Married 180 55.4
Divorced 4 1.2
Educational level
College 226 69.5
Secondary school 77 23.7
Intermediate school and below 22 6.7

Discussion

IBS is troublesome and should not be underestimated because it carries a significant negative impact on the quality of life and social functioning in many patients with increase in absence rates from schools and workstations [16]. The prevalence of IBS varies between countries Several cross-sectional surveys have presented IBS prevalence, however, no latest systematic review of knowledge from all studies has been conducted to complete its global prevalence. Pooled prevalence of all studies was 11.2% (95% CI, 9.8%–12.8%). The best prevalence values were designed once ≥3 Manning criteria (14%; 95 CI, 10 0%–17.0%); by adopting the Rome I and Rome II criteria, prevalence values were 8.8% (95% CI, 6.8%–11.2%) and 9.4% (95% CI, 7.8%–11.1%), respectively. Socioeconomic status showed no influence, except four studies that reported such data [24]. A cross-sectional study was conducted in Al Jouf, Northern Kingdom of Saudi Arabia (KSA), involving a self-administered form supported Manning and Rome II criteria for diagnosing IBS. The study contained 2,025 middle school males’ students. The prevalence of IBS was 8 9% and 9 2% per Manning and Rome II criteria for diagnosing IBS, in patients with mean age of 17.5 ± 3 years and variation of 15–23 years [16]. Another study involving a self-administered questionnaire was based on Rome III criteria for diagnosis of IBS. It was conducted in King Abdulaziz University, Jeddah, KSA. The study included 597 medical students. The IBS prevalence was 31.8% [25]. A cross-sectional study done by a self-administered questionnaire based on Rome III criteria for diagnosis of IBS, which was conducted in Qassim region, KSA. The prevalence among 300 teachers was 40.7% with no significant gender predilection [20]. In a systemic review which involved 16 studies, IBS prevalence among the medical students ranged from 9.3% to 35.5%. The high prevalence among medical students might be due to their stressful learning atmosphere [26]. Another survey based on Rome III criteria for diagnosis of IBS conducted in King Abdulaziz University Hospital, Jeddah, KSA. The study included 229 nurses. The prevalence of IBS among nurses was 14.4%, and IBS-Mixed type was the most common type (54.5%) [27]. A significant association was found between gender and IBS, and anxiety levels and IBS [28]. In a cross-sectional study to assess the bowel patterns (function/habits) and its associated variables in adult Saudi population, 40% of both genders had bowel movements at least once a day [17].

Table 2. Knowledge of the participants regarding IBS.

Knowledge
Excellent Acceptable Poor p-value
IBS is a serious condition that could decrease the quality of life (T) 78.2% 7.6% 14.2% 0.001
IBS could shorten the life of the subjects (F) 47.7% 17.8% 34.5% 0.0001
IBS is more common than diabetes and hypertension (F) 47.7% 12.6% 39.7% 0.0001
Colon cancer is more prevalent than IBS (F) 58.8% 21.8% 19.4% 0.0001
Dietary factors, Food allergies and food intolerances are associated high incidence with IBS (T) 86.8% 6.2% 7.1% 0.021
Genetic predisposition, a preceding viral or bacterial illness are major risk factors for IBS (T) 58.5% 17.8% 23.7% 0.0001
Psychological and emotional attribution are common disorders associated with IBS (T) 89.8% (292) 3.7% 6.5% 0.2
The common symptoms include diarrhea, constipation, abdominal pain and bloating (T) 91.4% 3.4% 5.2% 0.002
The diagnosis of IBS is based on recognition of the symptoms (T) 53.5% 9.8% 36.6% 0.002

Table 3. Beliefs of the participants regarding IBS

Attitude and beliefs
Excellent Acceptable Poor p-value
Dietary changes could improve IBS symptoms (T) 91.1% 5.5% 3.4% 0.04
Prescription medications could improve IBS symptoms (T) 79.7% 8% 12.3% 0.04
Alternative medications could improve the IBS status (F) 44.6% 13.5% 41.8% 0.0001
Alternative medications or treatments (acupuncture, herbs, teas, roots, crystals, etc). could improve the IBS status (T) 40% 21.8% 38.2% 0.0001
Counseling (with a social worker, psychiatrist, or psychologist) could improve the IBS status (T) 74.8% 13.5% 11.7% 0.0001
Surgery could improve the IBS status (F) 51.8% 21.5% 20.6% 0.0001

This study has strengths and limitations. The limitations are: the majority of participants were of young age, in addition, great number of highly educated participants answered the questionnaire which does not represent the whole population, sample size, and interview was difficult to be done due to the refusal to participate. This study being the first one to evaluate the knowledge and related risk factors of community subjects toward IBS in Alahsa region, marks the strength of this study.

Conclusion

It is concluded that a great number of participants had good knowledge about the symptoms, signs, risk factors, prognosis, and management of the disease. A health care program is recommended to take the responsibility to enhance the knowledge and awareness about the disease and to reduce the rate by preventing the triggers. Also, larger observational studies are needed to be conducted to calculate the prevalence accurately and assess the IBS patients in local public health care centers.

List of Abbreviations

IBS Irritable bowel syndrome

KSA Kingdom of Saudi Arabia


Funding

None.


Declaration of conflicting interests

None.


Consent for publication

Informed consent was obtained from all participants.


Ethical approval

Ethics and Research Committee College of Medicine, King Faisal University, Alahsa, Saudi Arabia approved the study.


Author details

Abdul Sattar Khan1, Hassan Ali Al Sayegh2, Mustafa Mohammed Al Ali2, Abdulaziz Adel Al Qurini2, Hassan Fahmi AlKhars2, Ali Ahmed AlKhars3

  1. Department of Family Medicine, College of Medicine, King Faisal University, Alahsa, Saudi Arabia
  2. Medical Intern, College of Medicine, King Faisal University, Alahsa, Saudi Arabia
  3. Medical Intern, College of Medicine, Imam Abdulrahman Bin Faisal University

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Appendix

Table 4. Demographic of included Saudi subjects

Characteristics of interviewees
Gender Male Female
Age 18–24 Years 25–34Years 35–44 Years 45–54 Years 55–64 Years 65+
Education Primary school Secondary school High school University degree
Marital status Married Other
Family history of IBS Yes No
Previous diagnosis of IBS by physician Yes No
Symptoms of IBS in the last month according to Rome III criteria 1-Recurrent abdominal pain or discomfort for at least 3 days per month during the past 3 months, associated with two or more of the following features: (a) improvement with defecation; and/or (b) onset associated with a change in frequency of stool; and/or (c) onset associated with a change in form (appearance) of stool.

Table 5. Knowledge and beliefs of the participants regarding IBS.

IBS is a serious condition that could decrease the quality of life (T) Correct Incorrect
IBS could shorten the life of the subjects (F) Correct Incorrect
IBS is more common than diabetes and hypertension (F) Correct Incorrect
Colon cancer is more prevalent than IBS (F) Correct Incorrect
Dietary factors, Food allergies and food intolerances are associated high incidence with IBS (T) Correct Incorrect
Genetic predisposition, a preceding viral or bacterial illness are major risk factors for IBS (T) Correct Incorrect
Psychological and emotional attribution are common disorders associated with IBS (T) Correct Incorrect
The common symptoms include diarrhea, constipation, abdominal pain and bloating (T) Correct Incorrect
Dietary changes could improve IBS symptoms(T) Correct Incorrect
Prescription medications could improve IBS symptoms (T) Correct Incorrect
Alternative medications could improve the IBS status (F) Correct Incorrect
Alternative medications or treatments (acupuncture, herbs, teas, roots, crystals, etc). could improve the IBS
status (T)
Correct Incorrect
Counseling (with a social worker, psychiatrist, or psychologist) could improve the IBS status (T) Correct Incorrect
Surgery could improve the IBS status (F) Correct Incorrect
The diagnosis of IBS is based on recognition of the symptoms (T) Correct Incorrect
Differential diagnosis could enhance the early recognition of the syndrome Correct Incorrect


How to Cite this Article
Pubmed Style

Abbasi V, Molaei B, Mobaraki N, Anari H. Knowledge and attitude toward epilepsy among Ardabil Medical University students and staff, Ardabil, Iran. IJMDC. 2019; 3(9): 30-33. doi:10.24911/IJMDC.51-1550557218


Web Style

Abbasi V, Molaei B, Mobaraki N, Anari H. Knowledge and attitude toward epilepsy among Ardabil Medical University students and staff, Ardabil, Iran. http://www.ijmdc.com/?mno=32255 [Access: September 23, 2019]. doi:10.24911/IJMDC.51-1550557218


AMA (American Medical Association) Style

Abbasi V, Molaei B, Mobaraki N, Anari H. Knowledge and attitude toward epilepsy among Ardabil Medical University students and staff, Ardabil, Iran. IJMDC. 2019; 3(9): 30-33. doi:10.24911/IJMDC.51-1550557218



Vancouver/ICMJE Style

Abbasi V, Molaei B, Mobaraki N, Anari H. Knowledge and attitude toward epilepsy among Ardabil Medical University students and staff, Ardabil, Iran. IJMDC. (2019), [cited September 23, 2019]; 3(9): 30-33. doi:10.24911/IJMDC.51-1550557218



Harvard Style

Abbasi, V., Molaei, . B., Mobaraki, . N. & Anari, . H. (2019) Knowledge and attitude toward epilepsy among Ardabil Medical University students and staff, Ardabil, Iran. IJMDC, 3 (9), 30-33. doi:10.24911/IJMDC.51-1550557218



Turabian Style

Abbasi, Vahid, Behnam Molaei, Noushin Mobaraki, and Hasan Anari. 2019. Knowledge and attitude toward epilepsy among Ardabil Medical University students and staff, Ardabil, Iran. International Journal of Medicine in Developing Countries, 3 (9), 30-33. doi:10.24911/IJMDC.51-1550557218



Chicago Style

Abbasi, Vahid, Behnam Molaei, Noushin Mobaraki, and Hasan Anari. "Knowledge and attitude toward epilepsy among Ardabil Medical University students and staff, Ardabil, Iran." International Journal of Medicine in Developing Countries 3 (2019), 30-33. doi:10.24911/IJMDC.51-1550557218



MLA (The Modern Language Association) Style

Abbasi, Vahid, Behnam Molaei, Noushin Mobaraki, and Hasan Anari. "Knowledge and attitude toward epilepsy among Ardabil Medical University students and staff, Ardabil, Iran." International Journal of Medicine in Developing Countries 3.9 (2019), 30-33. Print. doi:10.24911/IJMDC.51-1550557218



APA (American Psychological Association) Style

Abbasi, V., Molaei, . B., Mobaraki, . N. & Anari, . H. (2019) Knowledge and attitude toward epilepsy among Ardabil Medical University students and staff, Ardabil, Iran. International Journal of Medicine in Developing Countries, 3 (9), 30-33. doi:10.24911/IJMDC.51-1550557218