Irritable bowel syndrome: prevalence, risk factors in an adult ...

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain and alterations in bowel habits [1]. Skiptomaincontent Advertisement SearchallBMCarticles Search DownloadPDF Researcharticle OpenAccess Published:02December2017 Irritablebowelsyndrome:prevalence,riskfactorsinanadultLebanesepopulation RajaaChatila1,MahmoudMerhi1,EssaHariri1,NadaSabbah1&MaryE.Deeb1  BMCGastroenterology volume 17,Article number: 137(2017) Citethisarticle 6653Accesses 13Citations 10Altmetric Metricsdetails AbstractBackgroundVeryfewstudiesreportontheprevalenceofirritablebowelsyndrome(IBS)anditscorrelatesintheMiddleEast.ThisstudyinvestigatedIrritableBowelSyndrome(IBS)prevalenceinasampleofLebaneseadultindividualsandassociateddemographicandbehaviorallifestylefactors.MethodsThisisanobservationalpopulation-basedstudy.ThetargetpopulationisworkingLebaneseadults,eighteen-to-sixtyfiveyearsold.ThesamplewasselectedfromaconveniencepopulationofbankemployeesindifferentgeographicalareasinLebanon.Thestudyparticipantscompletedananonymousself-administeredquestionnaire,tocollectdataontheirsocio-demographic,behavioralandlifestylecharacteristics,anddiagnosticquestionsfollowingRomeIIIcriteriatoassessIBSoccurrence.ThedifferenceinIBSprevalencebysocio-demographiccharacteristics,smoking,alcoholconsumption,andphysicalactivitywasassessedbyusingtheChi-squaretest.LogisticregressionadjustedoddsratioswereusedtoinvestigatetheassociationbetweenriskfactorsandIBS.ResultsDatawascollectedfrom553individualsandconsistedof52.8%females(meanage35.9 years,SD = 11.9)and47.2%males(meanage = 36.1 years,SD = 10.3).TheprevalenceofIBSinthestudypopulationaccordingtoRomeIIIcriteriawas20.1%.Thebivariateanalysisindicatedthatbeingyoungerthan30 yearsold,afemale,aneverwaterpipesmoker,aneveralcoholconsumeraresignificantlyassociatedwithahigherprevalenceofIBS.Educationallevel,cigarettessmokingandphysicalexercisewerenotsignificantlyassociatedwithIBSoccurrence.Thelogisticregressionadjustedoddsratioshowedthatfemaleswere1.67timesmorelikelytohaveIBSthanmales(P˂0.05).Theparticipantsagedlessthan30 yearsoldwereatahigherriskofhavingIBS(P˂0.01).Thosewhoeversmokedwaterpipewere1.63timesmorelikelytohaveIBSthanthosewhoneversmokedwaterpipe(P˂0.05).ThosewhowereeveralcoholdrinkersweretwiceaslikelytohaveIBSthannever-drinkers(P˂0.01).ConclusionNewdataonthehighprevalenceofIBSinanadultpopulationinLebanonhasbeenreported.ThisisalsothefirststudytoinvestigateandshowanassociationofwaterpipesmokingandIBS.Furtherlongitudinalstudiesarewarrantedtodeterminewhetherthisassociationiscausal. PeerReviewreports BackgroundIrritablebowelsyndrome(IBS)isafunctionalgastrointestinaldisordercharacterizedbyabdominalpainandalterationsinbowelhabits[1].TheglobalprevalenceofIBSisestimatedtobe11.2%,anditisthemostcommonfunctionalgastrointestinaldisease.IBSisnotalife-threateningcondition,yetpeoplewithIBShaveareducedqualityoflifethatmayaffecttheireducational,socialandoccupationalachievements[2].TheeconomicburdenofIBSissubstantialonthehealthcaresystemtoo.ThedirectannualcostofdiagnosingandtreatingIBSintheUnitedStatesisestimatedbetween$1.7and$10billion.Theindirectcostsintermsofabsenteeism,workdayslost,disabilitywilldoublethemonetaryfigureestimatedasdirectcosts[3].ThereareseveralcriteriafordiagnosingIBSincludingRomeI,RomeIIandManningcriteria,butthemostwidelyusedmethodistheRomeIIIcriteria[4].Thus,theuseofdifferentdiagnosticcriteriawillaffectthereportedIBSprevalenceworldwide.StudiesusingtheRomeIIIcriteria,reporttheprevalenceofIBSinWesterncountriesrangefrom10to20%[5]comparedwith1to10%intheAsiancountries[6].ThelowestreportedrateswereinSoutheastAsia(7.0%)whilethehighest(21.0%)wereinSouthAmerica.TheprevalenceofIBSvariesbysocio-demographicfactors,genderandage[7,8].Indevelopedcountries,womenare2-4timesmorelikelytodevelopIBScomparedtomen[7,9].IBSismoreprevalentamongadolescentsanddeclineswithage[10].TheoddsofhavingIBSarehigheramongthoseyoungerthan50 yearscomparedtothoseolderthan50 yearsofage[11,12,13].Lifestylefactorssuchassmoking,alcoholconsumption[14,15,16]andphysicalactivity[17,18]havealsobeenlinkedtoIBS.Moreover,IBShasbeenassociatedwithpsychologicalfactorssuchasstressandanxiety[6,8],aswellasgeneticsfactorswhere33%ofpatientswithIBSreportapositivefamilyhistory[19].EpidemiologicstudiesassessingtheprevalenceofIBSanditscorrelatesarelackinginthedevelopingworldandspecificallyinAfricanandMiddleEasterncountries,particularlyinLebanon.LebanonisaMiddleEasternmiddle-incomecountrywithapopulationofaboutfourmillionthatexperiencedaprotractedcivilwarforalmosttwodecadesfrom1975to1990.ArecentstudyamonguniversitystudentsinLebanonreportsaprevalenceof20%usingtheRomeIIIcriteria[17].Thus,thecurrentstudyaimsto(1)estimatetheprevalenceofIBSinaLebanesepopulationbasedonasampleofemployedadultsandto(2)assessthebehavioralriskfactors,includingsmoking,waterpipe,alcoholuseandphysicalinactivityassociatedwiththedisease.MethodsStudydesignandrecruitmentofstudyparticipantsThisisanobservational,population-basedstudy.ThetargetpopulationisLebaneseadults,eighteen-to-sixtyfiveyearsold.ThesamplewasselectedfromaconveniencepopulationofbankemployeesinLebanon.Thechoiceofbankemployeeswasbasedontherationalethattheyrepresentasignificantpercentoftheprivateworkingforce.BankemployeesalsoprovideasufficientwideagerangeofacohortofworkingadultsinLebanon.Theselectedbankswerelocatedinmajorcitiesacrossthecountry:Beirut,thecapital,TripoliandByblos,intheNorth,ZahleandChtauraintheBekaa,andSaida,TyreandNabatiehintheSouthofLebanon.AllmajorbanksinBeirutwerecontactedinitiallybye-mailtorequesttheadministrationapprovaltoconductthesurveyamongtheiremployeesinthemainheadquartersinthecityofBeirut,aswellasbranchesinothercities.TheselectedbankswererepresentativeoftheLebanesebankingsector,astheyconstitutedthemajorbanksinthecountry.Themajority(95%)ofthecontactedbanksagreedtoparticipate.ThedatacollectionextendedfromJanuary2016toApril2016.Theemployeeswereinformedaboutthesurveybytheadministrationandaskedforvoluntaryparticipationinthestudy.Thequestionnairesweredistributedandcollectedbythestudyteamduringworkinghours(Additionalfile1).Theconsentingparticipantswereaskedtoreturnthefilledquestionnaireinasealedenvelopeanddepositedinanassignedboxforconfidentiality.Theresponserateindifferentbanksvariedfrom70%to80%.BankemployeeswereexcludediftheyhadahistoryofCrohn’sdisease,ortreatedforpepticulcerdiseases.Ascreeningquestionwasusedtoexcludethenon-eligibleparticipants.Theresearchteamapproachedtheconsentingbankemployeesandinquired:HaveyoueverbeendiagnosedwithCrohn’sdisease?Areyoucurrentlytakingmedicationforpepticulcerdisease?.Anyrespondentwhorespondedyestoanyofthesetwoquestionswasnoteligibletoparticipateinthestudy.Alleligibleemployeesintheselectedbankscompletedafifteenminutesanonymousself-administeredquestionnaire.Thequestionnaireincludedaconsentformonitscoverpage,allparticipantscompletingthequestionnairewereconsideredtobeindirectlyprovidingtheirinformedconsent.TheLebaneseAmericanUniversityInstitutionalReviewBoard(IRB)committeereviewedandapprovedthebankrequestformalletteraswellasthestudyquestionnaire.DatatoascertainprevalenceanddiagnosisofIBSwerebasedontheRomeIIIcriteriaforFunctionalGastrointestinalDisorders.IBSisdefinedasrecurrentabdominalpainordiscomfortinthelastthreemonthsforatleast3 dayspermonth,associatedwithatleasttwoofthefollowing:reliefafterdefecation;changesinbowelmovementfrequency,andoccurrenceofsymptomsassociatedwithchangesinstoolform[20].Thequestionnairecollecteddataonsocio-economic,demographicandbehavioralcharacteristics(sex,age,educationandregionaldistribution),smokingpatterns(cigarettes,waterpipe,cigarsandpipe),alcoholconsumptionphysicalactivityandfoodintolerance.SamplesizeThesamplesizecalculationbasedontheprobabilitythattheprevalenceofIBSis20%inthepopulationandtheerrorintheestimateof±3.4%witha95%confidenceintervalyieldedarequiredsamplesizeof532individuals.StatisticalanalysisThedatawasanalyzedusingtheStatisticalPackageforSocialSciences(Version23.0.IBMCorporation,Arnouk,USA).TheassociationbetweenIBSandsocio-demographiccharacteristics,smoking,alcoholconsumption,physicalactivityandfoodintolerancewasassessedbyChi-square.Logisticregressionwasusedtopredicttheindependentassociationofdemographicfactors,smoking,alcoholconsumption,andphysicalactivityontheoddsofhavingIBS.Ap-valuelessthan0.05indicatedstatisticalsignificance.ResultsThetotalnumberofquestionnairescollectedwas612butsomehadtobediscardedduetoincompleteinformationonIBSandothercharacteristics.Thefinalsamplesizewas553individualsandconsistedof52.7%femalesand47.3%males.Themeanageamongthefemaleswas35.9 years(SD=11.9)andmales36.1 years(SD=10.3).Themajorityofthesamplehadauniversitydegree65.3%,17.3%completedhigherstudiesand17.4%hadeithersecondaryeducationoratechnicalschooldegree,(Table 1).Table1DistributionofparticipantsbyselectedcharacteristicsFullsizetable (Table1tobeinsertedhere)PrevalenceandbivariateassociationofIBSbyriskfactorsTheprevalenceofIBSinthestudypopulationaccordingtoRomeIIIcriteriawas20.1%.Itvariedbysocio-demographicandlifestylefactors.TheprevalenceofIBSwashigheramongfemales(22.9%)comparedtomales(16.9%)(P˂0.05).AgewasnegativelyrelatedtoIBS,studyparticipantsolderthan30 yearsreportedlessIBSthanthoseyoungerthan30 yearsofage.(P˂0.01).Nosignificantdifferencewasobservedwithrespecttotheeducationalleveloftherespondents,(Table 2).Table2DistributionofIBSprevalencebyrespondentcharacteristics.IrritableBowelSyndromeFullsizetable (Table2tobeinsertedhere)CigarettessmokingTheprevalenceofcurrentcigarettesmokinginthetotalsamplewas31.3%,with12.8%beingpastsmokers,andtheremaining55.9%havingneversmoked.Theprevalenceofcigarettesmokingwashigher(P˂0.001)amongmales(56.3%)comparedtofemales(33.2%).Smokingwasmoreprevalent(P˂0.003)amongthosewhohadasecondaryeducationoratechnicalschooldegree(57.9%)comparedtothosewithauniversitydegreeorhigherstudies42.4%and39.4%respectively.NosignificantdifferenceinIBSprevalencewasobservedbetweenthosewhoeversmokedandthosewhoneversmokedcigarettes,(Table2).WaterpipesmokingTheprevalenceofcurrentwaterpipesmokingwas36.6%,10.1%werepastsmokers,while53.3%neversmoked.Nosexoreducationalleveldifferentialwasnotedamongwaterpipesmokers.Table2showthatIBSoccurredmorefrequentlyamongeverwaterpipesmokers(24.0%)thanthosewhoneversmokedwaterpipe(16.6%)(P˂0.01).AlcoholconsumptionTheprevalenceofreportedcurrentalcoholconsumptionwas31.4%with6.9%beingpast-drinkersand61.7%neverconsumedalcohol.Malesreportedagreater(P˂0.01)alcoholconsumption(47.6%)comparedtofemales(34.8%).Alcoholconsumptionwasmoreprevalent(P˂0.0001)amongthosewhohadauniversityorcompletedhigherstudies(58.2%)comparedtothosewithsecondaryeducationortechnicalschool(38.1%).Table2showedthatIBSwasmoreprevailing(P˂0.001)amongalcoholdrinkers(26.5%)comparedtoneveralcoholdrinkers(16.1%).PhysicalactivityTheprevalenceofphysicalactivitywas63.9%,where24.4%reportedexercisinglessthanonceperweek,25.5%exercised2to3timesperweekand14.0%exercisedmorethan3timesperweek.Ahigherproportionofmales(P˂0.0001)werephysicallyactive(77.9%)comparedtofemales(53.8%),whilenodifferenceinactivitylevelwasnotedbetweenthosewithdifferentlevelsofeducation.TherewasnochangeinIBSoccurrencebyreportedphysicalactivity,(Table2).FoodintoleranceTherespondentswerealsoaskedtoreportiftheyexperienceanyfoodintolerance.Thosewhoreportedexperiencingfoodintolerance(n = 28)hadagreater(P˂0.05)occurrenceofIBS(35.7%)comparedtothosewhodidnotreportfoodintolerance(19.3%).LogisticregressionanalysisTable 3describestheadjustedoddsratioofIBScorrelatesandtheirconfidenceintervals.ThelogisticregressionshowedthattheoddsofhavingIBSare1.69timeshigherforfemalescomparedtomales(P˂0.05).Ayoungerageoflessthan30 yearsold,wasassociatedwithahigheroddsofIBSoccurrence1.80thanthoseolderthan30 yearsold.Thosewhoeversmokedwaterpipewere1.63timesmorelikelytohaveIBSthanthosewhoneversmokedwaterpipe(P˂0.05).AlcoholconsumersweretwiceaslikelytohaveIBScomparedtonon-alcoholconsumers(P˂0.05).PhysicalexerciseandcigarettesmokingwerenotsignificantlyassociatedwithhavingIBS.Table3LogisticRegressionofIBSoccurrencebydemographicandlifestyleriskfactorsFullsizetable (Table3tobeinsertedhere)DiscussionKeyfindingsThisstudyassessedtheprevalenceofIBSamongasampleofLebaneseemployeesaswellasmajorlifestyleassociations.Theprevalenceof20.1%amongthesampledadultparticipantswascomparabletotwostudiesofuniversitystudents,oneinLebanon[17]andarecentoneinneighboringSyria[21]aswellasestimatesreportedindevelopedcountries[6].HowevertheoccurrenceofIBSwasmuchhigherthanwhathasbeenreportedintheWest[2].ThereportedsexandagedifferentialamongthosewithIBSwasconsistentwithresultsreportedintheliterature[7,8].VarioushypotheseshavebeenproposedtoexplainthehigherprevalenceofIBSinfemales,i.e.higherserotoninsynthesisinthebrain[22],femalesexhormones’effectongastrointestinalmotility[23],andprobableassociationofIBSwithananti-nociceptivemechanismdiminishingpainrelatedtopelviceventssuchaspregnancyanddelivery[24].TheassociationofIBSwitheducationallevelisinconsistentinthereportedliterature,wheresomestudiesshowahigherprevalenceofIBSamongeducatedcomparedtolesseducated[25,26,27].Gweeetal.[28]reportedthatIBSissignificantlymoreprevalentamongthosewithmorethan6 yearsofpost-secondaryeducation.Yet,lowereducationwasassociatedwithahigherIBSprevalenceinonestudy[29].Therewasminimalvariabilityintheeducationalleveloftheparticipantsinourstudy;thereforesuchastatisticalassociationcouldnotbeanalyzedadequately.Behavioral(lifestyle)riskfactorsIndividualswhoconsumedalcoholinourstudyweretwiceaslikelytosufferfromIBScomparedtothosewhodidnot.TheassociationbetweenalcoholconsumptionandIBShasbeeninconsistentintheliterature,somestudiesreportnoeffect[14,15],whileothersshowthatalcoholconsumptionwasassociatedwithahigherIBSprevalence[16].Certainly,morestudiesarerequiredtoreachabetterunderstandingoftheassociationbetweenalcoholandIBS.OurstudyisthefirsttoinvestigatetherelationshipbetweenIBSandwaterpipesmoking.WaterpipesmokerswerefoundtohavesignificantlymoreIBScomparedtonon-smokers.Waterpipesmoking(HookahorShisha)isbecomingpopularincoffeeshopsacrosstheMiddleEastandNorthAfricaanditsprevalenceinLebaneseyouth(13-15 years)hasreached64.5%ofmalesand54.6%offemales;whereasitsprevalenceinLebaneseadults(18+years)isabout25.8%formalesand23.3%forfemales.Unfortunately,Lebanesewomenhavethehighestfemalereportedwaterpipesmokingrateintheregion[30].ThissocialhabitseemstohavespreadtoWesterncountriesnamelyinEurope[31,32].Cigarettesmokingwassignificantlymoreprevalentinmales(56.3%)comparedtofemales(33.2%),yetnosexdifferencewasnotedinwaterpipesmoking.OneprobableexplanationforthisdifferenceinsexprevalenceseenincigarettebutnotwaterpipesmokingcanberelatedtothewidesocialacceptanceofwaterpipeintheLebanesecultureandthelimitedknowledgeaboutitsrisks.Physicalactivityhasbeenshowntobeaneffectivemeasureinrelievinggas-relatedsymptoms,andiscurrentlyrecommendedforpeoplewhosufferfromabdominalbloatingasitimprovesimpairedgasclearancerelatedtoalteredsmallbowelactivity[33].AlthoughCostanianetal.[17],Kimetal.[18]andothers[34]haveconsistentlyshownhigherIBSprevalenceinthosewithlowphysicalactivityandthatactivityimprovedIBSsymptoms,ourstudyshowedthatphysicalactivitywasnotsignificantlyassociatedwithIBSoccurrenceinthisadultsampleoftheLebanesepopulation.TheroleoffoodintoleranceinprovokingorexacerbatingIBSsymptomshavebeenwelldescribedandconstitutethebasisofthelowFODMAPdiet[35].ThesignificantrelationshipobservedinourstudyofIBSinpatientreportingfoodintolerance,iswellestablishedandinagreementwithwhathasbeenreportedintheliterature.However,therespondentswerenotaskedwhattypeoffoodinducesthefoodintolerance,whichisastudylimitation.StudylimitationThereareseverallimitationsthatshouldbenotedinthisstudy.Thedatawascollectedthroughself-administeredquestionnairesthatmayleadtoahigherpercentageofincompletedatathaninterviewsurveys.Selectionbiasisalsopossibleaswelimitedthestudypopulationtobankemployeesthatmightalreadyhaveabettersocio-economicstatusandeducationallevelcomparedtothegeneralLebanesepopulation.Thiswasevidentinthefindingthat65%ofoursamplehadauniversitydegreecomparedto20%inthegeneralpopulationinLebanon.Moreover,otherfactorsknowntobeassociatedwithIBSwerenotaddressed,suchasdepressionandanxiety.Inaddition,theamountoftobaccouse,alcoholconsumption,andwaterpipeusewasnotquantified.ConclusionsInconclusion,theprevalenceofIBSinoursampleofemployedadultsinthebankingbusinesseswashigh,reachingtheupperlimitofworldwideprevalence(20%).GiventheimpactofIBSonthequalityoflifeofthoseafflictedwiththedisease,abetterunderstandingoftheprevalenceandassociatedsocioeconomicandbehavioralriskfactorsamongtheLebaneseisneeded.ThisisoneofthefirststudiestoestimatetheprevalenceofIBSanditsassociationwithlifestyleriskfactors(physicalactivity,waterpipesmokingandalcoholconsumption)inanadultsubsetoftheLebanesepopulation.WithrespecttowaterpipesmokinganditsassociationwithIBS,alongitudinalcohortstudy,controllingformajorconfounderssuchastressiswarrantedtoestablishcausalityofthisobservedcorrelation.FuturestudieswouldopenthedoortowardsanimprovedunderstandingofIBScomplexGIpathology,andallowahealthiermanagementgearedtowardsthepsychologicalandlifestylefactorsrelatedtoIBS. AbbreviationsIBS: Irritablebowelsyndrome P: P-value SD: Standarddeviation References1.CanavanC,WestJ,CardT.Theepidemiologyofirritablebowelsyndrome.Clinicalepidemiology.2014;6:71–80.[PMID:24523597PMCID:3921083DOI:10.2147/CLEP.S40245]PubMed  PubMedCentral  GoogleScholar  2.GralnekIM,HaysRD,KilbourneAM,ChangL,MayerEA.Racialdifferencesintheimpactofirritablebowelsyndromeonhealth-relatedqualityoflife.JClinGastroenterol.2004;38(9):782–9.[PMID:15365405]Article  PubMed  GoogleScholar  3.NellesenD,YeeK,ChawlaA,LewisBE,CarsonRT.Asystematicreviewoftheeconomicandhumanisticburdenofillnessinirritablebowelsyndromeandchronicconstipation.Journalofmanagedcarepharmacy:JMCP.2013;19(9):755–764[PMID:24156644.10.18553/jmcp.2013.19.9.755.Article  PubMed  GoogleScholar  4.MiwaH.PrevalenceofirritablebowelsyndromeinJapan:internetsurveyusingRomeIIIcriteria.Patientpreferenceandadherence.2008;2:143–7.[PMID:19920955PMCID:2770425]PubMed  PubMedCentral  GoogleScholar  5.SaitoYA,SchoenfeldP,LockeGRIII.TheepidemiologyofirritablebowelsyndromeinNorthAmerica:asystematicreview.AmJGastroenterol.2002;97(8):1910–1915[PMID:12190153.https://doi.org/10.1111/j.1572-0241.2002.05913.x.PubMed  GoogleScholar  6.ChangFY,LuCL,ChenTS.ThecurrentprevalenceofirritablebowelsyndromeinAsia.Journalofneurogastroenterologyandmotility.2010;16(4):389–400[PMID:21103420PMCID:2978391.https://doi.org/10.5056/jnm.2010.16.4.389.Article  PubMed  PubMedCentral  GoogleScholar  7.ChoungRS,LockeGRIII.EpidemiologyofIBS.GastroenterolClinNAm.2011;40(1):1–10[PMID:21333897.https://doi.org/10.1016/j.gtc.2010.12.006.Article  GoogleScholar  8.WhiteheadWE,DrossmanDA,etal.AmJGastroenterol.2010;105(4):814–820;quiz813,821[PMID:20179688PMCID:38562020.https://doi.org/10.1038/ajg.2010.56.Article  PubMed  GoogleScholar  9.ChangL,HeitkemperMM.Genderdifferencesinirritablebowelsyndrome.Gastroenterology.2002;123(5):1686–701.[PMID:12404243]Article  PubMed  GoogleScholar  10.LovellRM,FordAC.Globalprevalenceofandriskfactorsforirritablebowelsyndrome:ameta-analysis.Clinicalgastroenterologyandhepatology:theofficialclinicalpracticejournaloftheAmericanGastroenterologicalAssociation.2012;10(7):712–721e714[PMID:22426087.https://doi.org/10.1016/j.cgh.2012.02.029.Article  GoogleScholar  11.EndoY,ShojiT,FukudoS,MachidaT,MachidaT,NodaS,HongoM.ThefeaturesofadolescentirritablebowelsyndromeinJapan.JGastroenterolHepatol.2011;26(Suppl3):106–109[PMID:21443721.https://doi.org/10.1111/j.1440-1746.2011.06637.x.Article  PubMed  GoogleScholar  12.ParkH,LimS.Frequencyofirritablebowelsyndrome,entranceexamination-relatedstress,mentalhealth,andqualityoflifeinhighschoolstudents.Gastroenterologynursing:theofficialjournaloftheSocietyofGastroenterologyNursesandAssociates.2011;34(6):450–458[PMID:22129798.https://doi.org/10.1097/SGA.0b013e318237eb43.Article  GoogleScholar  13.ZhouH,LiD,ChengG,FanJ,LuH.AnepidemiologicstudyofirritablebowelsyndromeinadolescentsandchildreninSouthChina:aschool-basedstudy.ChildCareHealthDev.2010;36(6):781–786[PMID:20645991.https://doi.org/10.1111/j.1365-2214.2010.01120.x.CAS  Article  PubMed  GoogleScholar  14.RedingKW,CainKC,JarrettME,EugenioMD,HeitkemperMM.Relationshipbetweenpatternsofalcoholconsumptionandgastrointestinalsymptomsamongpatientswithirritablebowelsyndrome.AmJGastroenterol.2013;108(2):270–276[PMID:23295280PMCID:Pmc3697482.https://doi.org/10.1038/ajg.2012.414.Article  PubMed  PubMedCentral  GoogleScholar  15.LockeGRIII,ZinsmeisterAR,TalleyNJ,FettSL,MeltonLJ.Riskfactorsforirritablebowelsyndrome:roleofanalgesicsandfoodsensitivities.AmJGastroenterol.2000;95(1):157–165[PMID:10638576.https://doi.org/10.1111/j.1572-0241.2000.01678.x.Article  PubMed  GoogleScholar  16.LigaardenSC,LydersenS,FarupPG.Dietinsubjectswithirritablebowelsyndrome:across-sectionalstudyinthegeneralpopulation.BMCGastroenterol.2012;12(61)[PMID:22676475PMCID:3674839DOI:https://doi.org/10.1186/1471-230X-e12-61]17.CostanianC,TamimH,AssaadS.PrevalenceandfactorsassociatedwithirritablebowelsyndromeamonguniversitystudentsinLebanon:findingsfromacross-sectionalstudy.WorldJGastroenterol.2015;21(12):3628–3635[PMID:25834330PMCID:4375587.https://doi.org/10.3748/wjg.v21.i12.3628.Article  PubMed  PubMedCentral  GoogleScholar  18.KimYJ,BanDJ.Prevalenceofirritablebowelsyndrome,influenceoflifestylefactorsandbowelhabitsinKoreancollegestudents.IntJNursStud.2005;42(3):247–254[PMID:15708012.https://doi.org/10.1016/j.ijnurstu.2004.06.015.Article  PubMed  GoogleScholar  19.WhorwellPJ,McCallumM,CreedFH,RobertsCT.Non-colonicfeaturesofirritablebowelsyndrome.Gut.1986;27(1):37–40.[PMID:3949235PMCID:1433171]CAS  Article  PubMed  PubMedCentral  GoogleScholar  20.LongstrethGF,ThompsonWG,CheyWD,HoughtonLA,MearinF,SpillerRC.Functionalboweldisorders.Gastroenterology.2006;130(5):1480–1491[PMID:1667856e1.https://doi.org/10.1053/j.gastro.2005.11.061.Article  PubMed  GoogleScholar  21.SaadiTA,IdrisA,TurkT,AlkhatibM.Epidemiologyandriskfactorsofuninvestigateddyspepsia,irritablebowelsyndrome,andgastroesophagealrefluxdiseaseamongstudentsofDamascusUniversity,Syria.Journalofepidemiologyandglobalhealth.2016[PMID:27501053;https://doi.org/10.1016/j.jegh.2016.07.001.22.ParkDW,LeeOY,ShimSG,JunDW,LeeKN,KimHY,LeeHL,YoonBC,ChoiHS.ThedifferencesinprevalenceandSociodemographiccharacteristicsofirritablebowelsyndromeaccordingtoRomeIIandRomeIII.Journalofneurogastroenterologyandmotility.2010;16(2):186–193[PMID:20535350PMCID:2879846.https://doi.org/10.5056/jnm.2010.16.2.186.Article  PubMed  PubMedCentral  GoogleScholar  23.WaldA,VanThielDH,HoechstetterL,GavalerJS,EglerKM,VermR,ScottL,LesterR.Gastrointestinaltransit:theeffectofthemenstrualcycle.Gastroenterology.1981;80(6):1497–500.[PMID:7227774]CAS  PubMed  GoogleScholar  24.UnruhAM.Gendervariationsinclinicalpainexperience.Pain.1996;65(2-3):123–67.[PMID:8826503]CAS  Article  PubMed  GoogleScholar  25.XiongLS,ChenMH,ChenHX,XuAG,WangWA,HuPJ.Apopulation-basedepidemiologicstudyofirritablebowelsyndromeinSouthChina:stratifiedrandomizedstudybyclustersampling.AlimentPharmacolTher.2004;19(11):1217–1224[PMID:15153175.https://doi.org/10.1111/j.1365-2036.2004.01939.x.CAS  Article  PubMed  GoogleScholar  26.MinochaA,ChadW,DoW,JohnsonWD.Racialdifferencesinepidemiologyofirritablebowelsyndromealone,un-investigateddyspepsiaalone,and"overlapsyndrome"amongafricanamericanscomparedtoCaucasians:apopulation-basedstudy.DigDisSci.2006;51(1)218-226[PMID:16416240DOI:https://doi.org/10.1007/s10620-006-3112-4]27.DrossmanDA,McKeeDC,SandlerRS,MitchellCM,CramerEM,LowmanBC,BurgerAL.Psychosocialfactorsintheirritablebowelsyndrome.Amultivariatestudyofpatientsandnonpatientswithirritablebowelsyndrome.Gastroenterology.1988;95(3):701–8.[PMID:3396817]CAS  Article  PubMed  GoogleScholar  28.GweeKA,WeeS,WongML,PngDJ.Theprevalence,symptomcharacteristics,andimpactofirritablebowelsyndromeinanasianurbancommunity.AmJGastroenterol.2004;99(5):924–31.[PMID:15128362DOI:10.1111/j.1572-0241.2004.04161.x]Article  PubMed  GoogleScholar  29.AndrewsEB,EatonSC,HollisKA,HopkinsJS,AmeenV,HammLR,CookSF,TennisP,MangelAW,etal.AlimentPharmacolTher.2005;22(10):935–42.[PMID:16268967DOI:10.1111/j.1365-2036.2005.02671.x]CAS  Article  PubMed  GoogleScholar  30.SaltiN,ChaabanJ,NaamaniN.TheeconomicsoftobaccoinLebanon:anestimationofthesocailcostsoftobaccoconsumption.SubstUseMisuse.2014;49(6):735-42.DOI:10.3109/10826084.2013.863937.Epub2013Dec13.31.MaziakW,WardKD,EissenbergT.Factorsrelatedtofrequencyofnarghile(waterpipe)use:thefirstinsightsontobaccodependenceinnarghileusers.DrugAlcoholDepend.2004;76(1):101–6.[PMID:15380294DOI:10.1016/j.drugalcdep.2004.04.007]CAS  Article  PubMed  GoogleScholar  32.KnishkowyB,AmitaiY.Water-pipe(narghile)smoking:anemerginghealthriskbehavior.Pediatrics.2005;116(1):e113–9.[PMID:15995011DOI:10.1542/peds.2004-2173]Article  PubMed  GoogleScholar  33.VilloriaA,SerraJ,AzpirozF,MalageladaJR.Physicalactivityandintestinalgasclearanceinpatientswithbloating.AmJGastroenterol.2006;101(11):2552–7.[PMID:17029608DOI:10.1111/j.1572-0241.2006.00873.x]Article  PubMed  GoogleScholar  34.JohannessonE,SimrenM,StridH,BajorA,SadikR.Physicalactivityimprovessymptomsinirritablebowelsyndrome:arandomizedcontrolledtrial.AmJGastroenterol.2011;106(5):915–22.[PMID:21206488DOI:10.1038/ajg.2010.480]Article  PubMed  GoogleScholar  35.HalmosEP,PowerVA,ShepherdSJ,GibsonPR,MuirJG.AdietlowinFODMAPsreducessymptomsofirritablebowelsyndrome.Gastroenterology.2014;146(1):67–75.https://doi.org/10.1053/j.gastro.2013.09.046.CAS  Article  PubMed  GoogleScholar  DownloadreferencesAcknowledgementsWewouldliketoacknowledgethetremendoushelpindatacollectionofGhassanDayeandAhmadNaja.Ourgratitudeisalsoextendedtoallthebankemployeeswhoparticipatedinthestudy. Availabilityofdataandmaterials Thedatasetusedandanalyzedduringthecurrentstudyareavailablefromthecorrespondingauthoronreasonablerequest. AuthorinformationAffiliationsGilbertandRose-MarieChagourySchoolofMedicine,LebaneseAmericanUniversityMedicalCenter-RizkHospital,P.O.Box36,Byblos,LebanonRajaaChatila, MahmoudMerhi, EssaHariri, NadaSabbah & MaryE.DeebAuthorsRajaaChatilaViewauthorpublicationsYoucanalsosearchforthisauthorin PubMed GoogleScholarMahmoudMerhiViewauthorpublicationsYoucanalsosearchforthisauthorin PubMed GoogleScholarEssaHaririViewauthorpublicationsYoucanalsosearchforthisauthorin PubMed GoogleScholarNadaSabbahViewauthorpublicationsYoucanalsosearchforthisauthorin PubMed GoogleScholarMaryE.DeebViewauthorpublicationsYoucanalsosearchforthisauthorin PubMed GoogleScholarContributionsRCandMDcontributedtothestudyconceptionanddesign;RC,EH,MM,NS,MDcontributedtodatacollection,dataanalysisandinterpretationandwritingofthearticle;MDperformedallthestatisticalanalysis;Allauthorscontributedtoediting,reviewingandfinalapprovalofthearticle.Allauthorsreadandapprovedthefinalmanuscript.CorrespondingauthorCorrespondenceto RajaaChatila.Ethicsdeclarations Ethicsapprovalandconsenttoparticipate Thequestionnaireincludedaconsentformonitscoverpage,allparticipantscompletingthequestionnairewereconsideredtobeindirectlyprovidingtheirinformedconsent.TheLebaneseAmericanUniversityInstitutionalReviewBoard(IRB)committeereviewedandapprovedthestudy. Consentforpublication NotApplicable. Competinginterests Allauthorsspecificallystatethat“NoCompetinginterestsareatstakeandthereisNoConflictofInterest”withotherpeopleororganizationsthatcouldinappropriatelyinfluenceorbiasthecontentofthepaper. Publisher’sNote SpringerNatureremainsneutralwithregardtojurisdictionalclaimsinpublishedmapsandinstitutionalaffiliations. Additionalfile Additionalfile1:BloatingQuestionnaire.(DOCX98kb)Rightsandpermissions OpenAccessThisarticleisdistributedunderthetermsoftheCreativeCommonsAttribution4.0InternationalLicense(http://creativecommons.org/licenses/by/4.0/),whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedyougiveappropriatecredittotheoriginalauthor(s)andthesource,providealinktotheCreativeCommonslicense,andindicateifchangesweremade.TheCreativeCommonsPublicDomainDedicationwaiver(http://creativecommons.org/publicdomain/zero/1.0/)appliestothedatamadeavailableinthisarticle,unlessotherwisestated. ReprintsandPermissionsAboutthisarticleCitethisarticleChatila,R.,Merhi,M.,Hariri,E.etal.Irritablebowelsyndrome:prevalence,riskfactorsinanadultLebanesepopulation. BMCGastroenterol17,137(2017).https://doi.org/10.1186/s12876-017-0698-2DownloadcitationReceived:19March2017Accepted:20November2017Published:02December2017DOI:https://doi.org/10.1186/s12876-017-0698-2SharethisarticleAnyoneyousharethefollowinglinkwithwillbeabletoreadthiscontent:GetshareablelinkSorry,ashareablelinkisnotcurrentlyavailableforthisarticle.Copytoclipboard ProvidedbytheSpringerNatureSharedItcontent-sharinginitiative KeywordsIrritablebowelsyndromeRomeIIIcriteriaAlcoholCigarettesmokingWaterpipePhysicalactivityPrevalenceLebanon DownloadPDF AssociatedContent Section Epidemiologyofgastroenterologicaldisorders Advertisement BMCGastroenterology ISSN:1471-230X Contactus Submissionenquiries:[email protected] Generalenquiries:[email protected]