|Year : 2018 | Volume
| Issue : 2 | Page : 438-442
Quality of life in patients with irritable bowel syndrome in Qaliobeya Governorate, Egypt
Mahmoud A Qora1, Mohamed M EL Kot2, Aml A Salama2, Manar S Abd El Rahman3
1 Department of Internal Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
3 Department of Family Medicine, Ministry of Health, Shebin Elkom, Egypt
|Date of Submission||20-Nov-2016|
|Date of Acceptance||11-Dec-2016|
|Date of Web Publication||27-Aug-2018|
Aml A Salama
Department of Family Medicine, Faculty of Medicine, Shbeen El-Koom District, Menoufia Governorate
Source of Support: None, Conflict of Interest: None
The aim of this study was to assess the effect of irritable bowel syndrome (IBS) on health-related quality of life (QOL).
There has been an underestimation of the impact of IBS on an individual's functioning and QOL. The general health status of both young and elderly individuals with IBS is generally found to be poorer than that of the general population.
Patient and methods
This cross-sectional study included 400 IBS patients who attended to randomly selected family health center and two family health units of Qaliobeya Governorate in Egypt. All IBS patients who attended to the selected family health center and units and fulfilled the criteria of ROM III were included in the study sample. QOL was assessed through the 34-item, IBS-QOL questionnaire.
Older patients (≥30 years), female sex, receiving antispasmodic drugs, being overweight, and low socioeconomic standard were associated with better QOL. Patients who suffered dyspepsia, stomach pain, and flatulence encountered lower QOL.
QOL in patients with IBS is affected by age, sex, BMI, and presence of symptoms such as dyspepsia, flatulence, and stomach pain that may awake the patients at some nights.
Keywords: constipation-predominant IBS and diarrhea-predominant IBS, irritable bowel syndrome, quality of life
|How to cite this article:|
Qora MA, EL Kot MM, Salama AA, Abd El Rahman MS. Quality of life in patients with irritable bowel syndrome in Qaliobeya Governorate, Egypt. Menoufia Med J 2018;31:438-42
|How to cite this URL:|
Qora MA, EL Kot MM, Salama AA, Abd El Rahman MS. Quality of life in patients with irritable bowel syndrome in Qaliobeya Governorate, Egypt. Menoufia Med J [serial online] 2018 [cited 2019 Mar 20];31:438-42. Available from: http://www.mmj.eg.net/text.asp?2018/31/2/438/239748
| Introduction|| |
Irritable bowel syndrome (IBS) is defined as 'abdominal pain or discomfort that occurs in association with altered bowel habits over a period of at least 3 months' .
The pathophysiology of IBS is distinguishable from celiac disease and inflammatory bowel diseases (e.g., ulcerative colitis and Crohn's disease) as IBS does not present with gross organic or biochemical abnormalities . The pathophysiology of IBS is uncertain, and it is unlikely that a single unifying mechanism explains the condition, but abnormal gastrointestinal motor function, enhanced visceral perception, and abnormalities of central pain processing seem important .
Other determinants include psychosocial factors such as a history of childhood abuse, genetic predisposition, a history of exposure to acute enteric infection, so-called postinfectious IBS, and abnormalities in gut flora .
Symptoms of IBS include abdominal pain, change in bowel habits (diarrhea or constipation), bloating, and incomplete defecation. However, symptom presentation and severity vary, as current diagnostic criteria are based on symptoms .
The most frequently reported symptoms negatively impacting quality of life (QOL) in individuals with IBS are abdominal pain, bowel difficulties, bloating, and limitations in eating/diet restrictions .
Although constipation-predominant IBS and diarrhea-predominant IBS similarly impact QOL , bloating and diarrhea have the most negative impact on patient self-confidence and often leads to avoidance of social settings. IBS affects daily functioning, work and lifestyle, and interrupts sleep, which leads to increased fatigue .
For example, many individualss with IBS are forced to stay close to a toilet (>50%), are distressed by symptoms (69%), experience lack of control over their lives (57%), and are emotionally disturbed (upset, depressed, less confident, or worried). The degree of interruption of daily life is also related to coexisting or co-occurring conditions such as depression and anxiety. Relationships between stress and IBS have been reported by previous studies .
| Patients and Methods|| |
In this cross-sectional study, the calculated sample size was 400 using the Epi Info program (Epi Info, Atlanta, Georgia, USA) depending on the total number of population in the selected sites and the lowest prevalence in previous studies was taken into consideration in this calculation. The sample was a multistage random sample; one district (Toukh) out of seven districts of Qaliobeya was chosen randomly. Out of two family health centers and 26 family health units, one family health center and two family health unit (Elamar and Emyay units) were randomly selected with 2 days in each site. All patients fulfilling the ROM III criteria of IBS, in the selected sits and date were included.
Human rights and ethical considerations were followed during the study with total confidentiality of any obtained data. The Menoufia Faculty of Medicine committee for medical ethics of research formally approved the study before it began. A written consent form was taken from all participants after explaining the aim of the study. The study was conducted during the period from the beginning of June to the end of December 2014.
Diagnosed cases of IBS were the target population of this study. Patients have discomfort or pain anywhere in the abdomen for at least 3 months' duration between ages of 20 and 50 years. The condition is associated with diarrhea or constipation or diarrhea and constipation alternatively. Eligible patients were introduced to the study at the time of their arrival to the clinic and asked to complete the study questionnaires provided by a research associate. Patients who agreed to participate were handed a packet containing the study questionnaires to complete at the clinic.
The data from patients, such as age, sex, education, occupation, and their socioeconomic standard according to El-Gilany  were assessed and calculated as low, middle, and high.
Bowel disorder questionnaire
IBS status was defined by the presence of compatible symptoms after clinical exclusion of other potential organic causes. The bowel disorder questionnaire (BDQ)  consists of 21 questions that capture the presence, severity, and duration of several upper and lower gastrointestinal symptoms. Questions were used as the qualifying and diagnosis questions closely approximating the Rome III definition for IBS .
Irritable bowel syndrome quality of life questionnaire
The irritable bowel syndrome quality of life questionnaire (IBS-QOL)  is a disease-specific QOL measure for IBS consisting of 34 questions. It produces an overall score and eight subscale scores, including dysphoria, interference with activity, body image, health worry, food avoidance, social reaction, sexual functioning, and interpersonal relationships. The scores are transformed as a percentage from 0% (low functioning) to 100% (high functioning). The IBS-QOL has demonstrated high internal consistency (Cronbach's α = 0.95) and high reproducibility (intraclass correlation = 0.86). Convergent validity for the IBS-QOL showed that scores are more related to overall well-being than to function (compared with the short-form 36)  BMI based on each participant's height and weight at the time of survey. The normalized scores of QOL vary from 0 (worst possible QOL) to 100 (the best possible QOL).
For the primary analyses, the sample of participants was categorized into two groups, with and without IBS symptoms, based on BDQ responses . Health-related quality of life (HRQOL) was evaluated using the IBS-QOL and overall score and its eight subscales.
The t-tests were used for comparison of the IBS-QOL scales and summary scores between participants with and without IBS. Levene's test for equality of variances was carried out for each comparison. If equal variance was not present, the final t-test was performed using Satterthwaite's approximation for unequal variances.
Linear regression models were used to evaluate the potential contributions of IBS, demographic factors, and psychological factors toward HRQOL scores. The dependent variable for the IBS-QOL was the overall score. The independent variables for each linear regression were entered as follows: age, marital status, ethnicity, education, and BMI.
| Results|| |
As regards sociodemographic features [Table 1] for the 400 participants, the mean age of the patients was 36.18 ± 10.15 with a minimum age of 18 and a maximum age of 54 years. Female population constituted higher percentage compared with male population (55.7% were female vs. 44.3% male patients). Married patients constituted 77% of the studied group. Intermediate institute education constituted 54% of the studied group education. The incidences were higher among patients with no work, those from urban residence, and patients of middle socioeconomic status. Sex constituted a statistically significant determinant of patient QOL as it was better in female patients. QOL was statistically significantly better in older patients (≥30 year), in those receiving antispasmodic medications, in patients with less than four attacks/month, and surprisingly those overweight or of low standard of living [Table 2].
|Table 2: Effect of patient characteristics on their quality of life score|
Click here to view
Patients who suffered from dyspepsia and stomach pain had more statistically significant impairment of their HRQOL than those not suffering from dyspepsia. Patients who always complained of flatulence had statistically significantly lower scores as regards their QOL than those who suffered it sometimes or never complained of that. If IBSs were severe enough to awake the patients from sleep, it caused significant diminution of their HRQOL than in those who did not suffer that [Table 3].
|Table 3: Effect of patients' associated symptoms on their quality of life score|
Click here to view
In a logistic regression analysis, significant variables affecting QOL in the studied group were age of patients, sex, BMI, socioeconomic standard, number of attacks/month, flatulence, defecation urgency, and receiving antispasmodic drugs [Table 4].
|Table 4: Binary logistic regression analysis of the most relevant factors affecting quality of life in patients with irritable bowel syndrome according to ROM III (n=400)|
Click here to view
| Discussion|| |
This study was carried out to examine the disease-specific HRQOL measures in patients with IBS symptoms. IBS symptoms were associated with a significantly impaired HRQOL in IBS patients. The reduced HRQOL scores in IBS symptom-positive patients were both statistically significant and clinically meaningful.
These results support prior findings on IBS and HRQOL, which have shown that IBS patients have impaired HRQOL ,,, as well as high burden of psychological factors ,.
In the present study, QOL was statistically significantly better in older patients (≥30 year), female patients, those receiving antispasmodic medications, patients with less than four attacks/month, and surprisingly those who were overweight or of low standard of living. Park et al.  reported that female patients had significantly lower HRQOL compared with male patients. The IBS-QOL was significantly associated with female sex, the self-reported symptom severity, and level of education in the multivariate analysis. Significant impairment of HRQOL was only observed in patients with severe symptoms. Patients with mild and moderate symptoms showed only mild impairment (P < 0.01).
In a study that was conducted in France , women reported significantly (P < 0.05) poorer IBS-QOL scores compared with men. HRQOL deteriorated with time since the onset of IBS symptoms for some domains such as diet. A positive correlation was observed between low scores and intensity of pain and discomfort. IBS patients with a predominance of diarrhea exhibited significantly greater impairment of HRQOL in the emotional domain compared with IBS patients with constipation predominance (P ≤ 0.05). Park et al.  reported that female patients had a significantly lower HRQOL compared with male patients. The IBS-QOL was significantly associated with female sex, the self-reported symptom severity, and level of education in the multivariate analysis. Significant impairment of HRQOL was only observed in patients with severe symptoms (P < 0.01).
El-Serag et al.  concluded that the therapeutic management of IBS was associated with improvement in the QOL in those patients.
This study reported that no statistical significant effect of the subtype of IBS on QOL of the patients. Mönnikes  reported no major differences in HRQOL based on IBS subtype (constipation-dominant or diarrhea-dominant). However, the severity of bowel symptoms in IBS is associated with a corresponding impact on HRQOL and patients with worse bowel symptoms have a greater diminished QOL compared with patients with milder symptoms.
| Conclusion|| |
In the present study, QOL was affected by sex of patients, age less than 30, being underweight, number of IBS attacks, and associated symptoms.
Careful consideration of the factors that affected the QOL in IBS patients may help to individualize a therapeutic strategy to optimize long-term outcomes.
The authors thank patients who accepted to participate in this work.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Brandt LJ, Chey WD, Foxx-Orenstein AE. An evidence-based systematic review on the management of irritable bowel syndrome. Am J Gastroenterol 2009; 104:S1–S35.
Verdu EF, Armstrong D, Murray JA. Between celiac disease and irritablebowel syndrome: the 'no man's land' of gluten sensitivity. Am J Gastroenterol 2009; 104
Ford AC, Vandvik PO. Irritablebowelsyndrome. BMJ Clin Evid 2015; 2015
Kassinen A, Krogius-Kurikka L, Makivuokko H. The fecal microbiota of irritablebowel syndrome patients differs significantly from that of healthy subjects. Gastroenterology 2007; 133
Drossman DA, Morris CB, Schneck S. International survey of patients with IBS: symptom features and their severity, health status, treatments, and risk taking to achieve clinical benefit. J Clin Gastroenterol 2009; 43
Ringel Y, Williams RE, Kalilani L, Cook SF. Prevalence, characteristics, and impact of bloating symptoms in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol 2009;7:68–72.
El-Gilany A, El-Wehady A, El-Wasify M. Updating and validation of the socioeconomic status scale for health research in Egypt. East Mediterr Health J 2012; 18
Talley NJ, Phillips SF, Wiltgen CM 3rd
. Assessment of functional gastrointestinal disease: the bowel disease questionnaire. Mayo Clin Proc 1990; 65
Longstreth GF, Thompson WG, Chey WD. Functional bowel disorders. Gastroenterology 2006; 130
Patrick DL, Drossman DA, Frederick IO, DiCesare J, Puder KL. Quality of life in persons with irritable bowel syndrome: development and validation of a new measure. Dig Dis Sci 1998; 43
Savas LS, White DL, Wieman M. Irritable bowel syndrome and dyspepsia among women veterans: prevalence and association with psychological distress. Ailment Pharmacol Ther 2008; 29
Afendy A, Kallman JB, Stepanova M. Predictors of health-related quality of life in patients with chronic liver disease. Aliment Pharmacol Ther 2009; 30
Park JM, Choi MG, Kin YS. Quality of life of patients with irritable bowel syndrome in Korea. Qual Life Res 2009; 27
Halder SL, Locke GR, Talley NJ. Impact of functional gastrointestinal disorders on health-related quality of life: a population-based case-control study. Aliment Pharmacol Ther 2004; 19
Lea R, Whorwell PJ. Psychological influences on the irritable bowel syndrome. Minerva Med 2004; 95
Park JM, Choi MG, Kim YS, Choi CH, Choi SC, Hong SJ, et al.
Quality of life of patients with irritable bowel syndrome in Korea. Qual Life Res 2009; 18
Amouretti M, Le Pen C, Gaudin AF, Bommelaer G, Frexinos J, Ruszniewski P, et al.
Impact of irritable bowel syndrome (IBS) on health-related quality of life (HRQOL). Gastroenterol Clin Biol 2006; 30
El-Serag HB. Impact of irritable bowel syndrome: prevalence and effect on health-related quality of life. Rev Gastroenterol Disord 2003; 3
Mönnikes H. Quality of life in patients with irritable bowel syndrome. J Clin Gastroenterol 2011; 45
[Table 1], [Table 2], [Table 3], [Table 4]