Quality of Life in Patients with Irritable Bowel Syndrome: A Cross-Sectional Study in Tunisia

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This study aimed to assess the quality of life in Tunisian IBS patients and identify associated factors. Methods A prospective, single-center, cross-sectional study was conducted at Charles Nicole Hospital in Tunis from February 2019 to January 2020. One hundred patients meeting Rome IV criteria for IBS were included. Quality of life was assessed using the Medical Outcome Study Short Form 36 Health Survey (MOS SF-36), translated into Tunisian dialect. Sociodemographic and clinical data were also collected. Statistical analysis involved descriptive and univariate analyses. Results The mean age of participants was 50.53 years, with 65% being female. The overall SF-36 score was a mean of 41.2%, with Physical Component Summary (PCS) averaging 42.5% and Mental Component Summary (MCS) averaging 39.9%. All quality of life scores were significantly lower than those reported for the general Tunisian population. Factors associated with impaired quality of life included advanced age, female gender, low educational attainment, unemployment or private sector employment, low socioeconomic status, hypertension, hypothyroidism, overweight/obesity, diabetes, marital status, and constipation-predominant IBS. Specifically, constipation-predominant IBS (54% of cases) was associated with impaired mental quality of life. Conclusion IBS patients in Tunisia experience a significantly reduced quality of life across both physical and mental domains. Several modifiable sociodemographic and clinical factors contribute to this impairment. Addressing these factors through improved socioeconomic conditions, management of comorbidities, and psychological support could optimize patient care and improve their quality of life. Figures Figure 1 Figure 2 Introduction Functional bowel disorders (FBDs), particularly Irritable Bowel Syndrome (IBS), represent a significant global health burden [ 1 ]. IBS is characterized by chronic abdominal pain and altered bowel habits without identifiable organic abnormalities. Its prevalence is substantial, and it profoundly affects patients' daily lives, leading to reduced productivity, increased healthcare utilization, and impaired quality of life [ 2 , 3 ]. The diagnosis of FBDs, including IBS, is primarily clinical, relying on the Rome IV diagnostic criteria [ 4 ]. These criteria define IBS by recurrent abdominal pain, on average at least one day per week for the past three months, associated with two or more of the following: relation to defecation, a change in stool frequency, or a change in stool shape/consistency. For a diagnosis of IBS, these symptoms must have been present for at least six months prior to diagnosis and during the last three months. IBS is further classified into subtypes based on stool consistency using the Bristol Stool Scale: constipation-predominant (IBS-C), diarrhea-predominant (IBS-D), mixed-type (IBS-M), and non-specific (IBS-U). Despite the high prevalence and impact of IBS, there is a paucity of data specifically addressing the quality of life of IBS patients in Tunisia and the factors contributing to its impairment. This study aimed to fill this gap by measuring the quality of life in a cohort of Tunisian IBS patients and identifying the sociodemographic and clinical factors associated with its deterioration. Methods This was a prospective, single-center, cross-sectional study conducted in the outpatient department of the hepatogastroenterology service at Charles Nicole Hospital in Tunis. The study spanned one year, from February 2019 to January 2020. Inclusion criteria for participants were: * Patients followed up at the hepatology and gastroenterology outpatient clinic. * Patients meeting the Rome IV criteria for the diagnosis of irritable bowel syndrome. * Patients who agreed to complete the questionnaire. Exclusion criteria included: * Patients with comprehension difficulties. * Patients who refused to complete the questionnaire. * Patients with a neurological history. * Patients with at least one missing answer on the questionnaire. The IBS subtype was specifically chosen for this study due to its high frequency and the clarity of its diagnostic criteria. For each included patient, a socio-demographic and clinical information form was completed by the senior physician or resident on duty. This form collected data on age, sex, medical and surgical history, level of education, socioeconomic status, main clinical signs, disease duration, and Body Mass Index (BMI). Patients were classified according to their BMI as follows: normal weight (BMI 30 kg/m²). Quality of life was assessed using the Medical Outcome Study (MOS) Short Form 36 Health Survey (MOS SF-36 Health Survey), which was translated into Tunisian dialect [ 5 ]. The questionnaire was completed by the patients themselves whenever possible; for those with difficulties, assistance was provided by resident or intern physicians. The MOS SF-36 Health Survey, developed by Ware and Sherbourne in 1992, is a widely used health questionnaire applicable to individuals aged 14 and over [ 6 ]. It measures eight dimensions of health: Physical Function, Role Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role Emotional, and Mental Health. Scores for each dimension range from 0 to 100, with higher scores indicating better health. These eight dimensions are further summarized into two global scores: the Physical Component Summary (PCS) and the Mental Component Summary (MCS), in addition to an overall SF-36 score. Descriptive statistics were used to characterize the study population. Univariate analyses were performed to identify associations between sociodemographic and clinical parameters and the SF-36 scores (overall, PCS, and MCS). Results This study included 100 patients from the hepatology and gastroenterology department at Charles Nicolle Hospital in Tunis. The study population was predominantly female, with a male-to-female ratio of 0.53. The average age of patients was 50.53 years, ranging from 16 to 91 years, with a median age of 54 years. The majority of patients were between 35 and 65 years of age. The average age for women was lower than that for men (48.67 versus 53.45 years). Most patients (76%) were from the north of the country. Educational levels were relatively evenly distributed, with a slight predominance of secondary education. Half of the patients were unemployed, and among the employed, most worked in the liberal sector. Socioeconomic status, assessed by monthly income, revealed that half of the patients had an income between 400 and 1,000 dinars (with the minimum wage being approximately 400 dinars). Most patients were married (66%), and the average number of children was 2.2. Regarding clinical characteristics, he average Body Mass Index (BMI) of the patients was 27.53 kg/m², with a range of 19.03 to 44.12 kg/m². Thirty-five percent of patients were of normal weight, 40% were overweight, and the remaining 25% were considered obese. More than half of the patients had one or more comorbidities, predominantly diabetes (24%) and hypertension (26%). Hypothyroidism was present in 5% of patients. Sixteen percent had a history of surgery, mainly visceral and gynecological. Pain was a constant symptom among the patients. Constipation was the predominant bowel disorder, found in 65% of patients. Alternating diarrhea and constipation was noted in 11 patients. Based on Rome IV criteria, constipation-predominant IBS was the most common subtype (54%), followed by non-specific IBS (28%). Patients followed up in the outpatient clinic were mainly referred from emergency departments (45%), while 55% were referred from local health centers or private practitioners. Eighteen percent of patients resorted to self-medication, mainly with antispasmodics and transit regulators. Additionally, 36% (N = 36) used phytotherapy or homeopathic treatments, primarily herbal teas containing verbena, fennel seeds, and turmeric. Colonoscopy revealed dolichocolon in 34% of patients. Abdominal ultrasound showed hepatic steatosis in 21% of patients. When it comes ti th Quality of Life Assessment (SF-36 Scores), the overall SF-36 score for our patients had a mean of 41.2% (median 41.6%), with scores ranging from 22.3% to 56%. The interquartile range (IQ 25–75) was [35.8; 46.9]. The Physical Component Summary (PCS) score, reflecting physical quality of life, had a mean of 42.5% (median 42.9%), with scores ranging from 22.8% to 57.3%. The IQ 25–75 was [35.9; 49]. (Fig. 1 ) The Mental Component Summary (MCS) score, reflecting mental quality of life, had a mean of 39.9% (median 40.2%), with scores ranging from 21.8% to 54.8%. The IQ 25–75 was [34.7; 45.6]. (Fig. 2 ) All physical and mental quality of life scores in our IBS patient cohort were significantly lower than those reported for the general Tunisian population. The reserch of factors Associated with Quality of Life Impairment identified several factors as being associated with impaired quality of life (Table 1 ) : Table 1 Summary table of significant associations with MOS SF-36 items Score parameter Physical quality of life Mental quality of life Overall PCS PF RP BP GH MCS VT RE MH SF SF-36 Age 0,02 < Gender 0,025 0,002 0,002 0,005 0,008 0,013 0,036 0,003 Lev.education 0,003 0,017 0,005 0,007 < 0,011 Field of practice 0,01 0,009 0,047 < 0,005 SES* 0,016 0,04 0,013 0,003 0,01 0,004 0,005 0,007 0,01 0,001 Marital Status 0,028 Diabetes 0,04 0,008 0,021 Hypertension 0,023 0,014 0,042 0,032 0,041 Hypothyroidism 0,037 < 0,01 0,018 0,034 IBS-C** 0,019 0,01 0,036 0,017 0,049 Homeopathy/phytotherapy 0,031 Long colon 0,019 BMI 0,003 < 0,024 0,012 0,045 0,033 * Socio-economic Status ** Irritable Bowel Syndrome with predominant constipation Values represent p-values for statistically significant associations (p < 0.05). Empty cells indicate no statistically significant association was found for that parameter and SF-36 dimension . Table 1 Summary of Significant Associations Between Sociodemographic/Clinical Factors and MOS SF-36 Health Survey Dimensions Parameter Physical Component Summary (PCS) Physical Function (PF) Role Physical (RP) Bodily Pain (BP) General Health (GH) Mental Component Summary (MCS) Vitality (VT) Role Emotional (RE) Mental Health (MH) Social Functioning (SF) Overall SF-36 Age 0.02 <10 -3 Gender 0.025 0.002 0.002 0.005 0.008 0.013 0.036 0.003 Level of Education 0.003 0.017 0.005 0.007 <10 -3 0.011 Employment status 0.01 0.009 0.047 <1^{-3} 0.005 Socioeconomic Status (SES) 0.016 0.04 0.013 0.003 0.01 0.004 0.005 0.007 0.01 0.001 Marital Status 0.028 Diabetes 0.04 0.008 0.021 Hypertension 0.023 0.014 0.042 0.032 0.041 Hypothyroidism 0.037 <10 -3 0.01 0.018 0.034 IBS-C 0.019 0.01 0.036 0.017 0.049 Homeopathic/Herbal Treatment 0.031 Dolichocolon 0.019 BMI 0.003 <10 -3 0.024 0.024 0.012 0.045 0.033 *Note: Values represent p-values for statistically significant associations (p < 0.05). Empty cells indicate no statistically significant association was found for that parameter and SF-36 dimension. Age Physical health parameters (PCS and Physical Function) were inversely related to age (r=-0.348, p = 0.002; r=-0.396, p < 10^-3). Gender Men generally had higher scores than women across most SF-36 items, with statistically significant differences for overall SF36, MCS, PCS, Role Emotional (RE), Social Functioning (SF), Mental Health (MH), Vitality (VT), and Bodily Pain (BP). Education Low educational attainment was associated with impaired physical (PCS, Physical Function, Bodily Pain, General Health) and mental (Vitality) quality of life, as well as overall SF36. Employment Status Unemployed patients had the lowest average scores, while public sector employees had the best. Socioeconomic Status Low socioeconomic status was significantly associated with lower scores across almost all SF-36 items. Marital Status Single patients had higher average scores, with a significant association for the MCS score. Comorbidities : Diabetes: significantly affected psychological quality of life (Vitality, Social Functioning, MCS). Hypertension: significantly associated with lower physical (PCS, Physical Function, Bodily Pain), mental (Vitality), and overall (SF36) quality of life scores. Hypothyroidism: Linked to lower overall SF36, physical (PCS, Role Physical, Bodily Pain), and mental (Role Emotional) quality of life scores. IBS Subtype: constipation-predominant IBS was significantly associated with lower mental quality of life scores (MCS, Social Functioning, Mental Health, Vitality) and overall SF-36. Dolichocolon: significantly associated with the Role Emotional mental health score, and all scores were lower in patients with this feature. Body Mass Index (BMI): increased BMI was significantly associated with lower physical (General Health, Physical Function, PCS), mental (Vitality, MCS), and overall (SF36) quality of life scores. Discussion This study aimed to assess the quality of life (QoL) in patients with Irritable Bowel Syndrome (IBS) at the Hepatology and Gastroenterology Department of Charles Nicolle Hospital, Tunis, and to identify associated sociodemographic and clinical factors. Our findings, derived from a prospective study of 100 patients between February 2019 and January 2020, reveal significant insights into the multifaceted impact of IBS on patient well-being within a Tunisian context. The use of the MOS SF-36 questionnaire, translated and validated into Tunisian dialect [ 4 ], ensured cultural appropriateness and reliability in QoL assessment [ 5 ]. Sociodemographic Factors and Quality of Life Our study identified several sociodemographic factors significantly associated with impaired quality of life. A female predominance (65% of patients) was observed, consistent with global epidemiological trends in IBS [ 7 ], although the sex ratio (0.54) was less pronounced than in some Moroccan and Iranian studies (0.28 and 0.23 respectively) [ 7 , 8 ]. This gender disparity is a consistent finding in IBS research, often attributed to hormonal factors, differences in pain perception, and healthcare-seeking behaviors. The average age of our cohort was 50.53 years, which is higher than reported averages in Algerian (41.8 years) [ 7 ], Moroccan (44 years) [ 8 ], and Iranian (30.8 years) studies [ 9 ]. This discrepancy could be indicative of delayed diagnosis or consultation patterns within the Tunisian healthcare system, where patients might resort to self-medication or alternative therapies before seeking specialized medical attention. This delay could lead to a more chronic and severe disease presentation by the time patients are included in studies, thus impacting their QoL more profoundly. Educational attainment emerged as a significant factor, with lower educational levels being associated with poorer physical health (PCS) and overall QoL. Similarly, employment status, particularly unemployment or employment in the private sector, and lower socioeconomic status (SES) were consistently linked to reduced PCS, MCS, and overall SF-36 scores. These findings underscore the socioeconomic gradient in health outcomes, where limited resources, stressful work environments, and financial strain can exacerbate the physical and psychological burden of chronic conditions like IBS. The predominance of average incomes in our cohort, while seemingly contradictory to some meta-analyses on IBS prevalence across socioeconomic levels (1), might reflect the evolving landscape of private healthcare access in Tunisia, where individuals with some financial capacity might seek specialized care. Marital status also played a role, with married individuals showing an association with lower MCS scores. This finding, while consistent with Japanese and British studies [ 10 ], regarding marital prevalence, warrants further investigation to understand the specific dynamics within marital relationships that might influence mental health in IBS patients [ 11 ]. Clinical Factors and Quality of Life Several clinical factors were found to significantly impact the quality of life in our IBS patient population. The high prevalence of overweight (40%) and obesity (25%), resulting in an average BMI of 27.53, is a notable finding. Overweight/obesity was associated with impaired PCS, MCS, and overall QoL. This aligns with a Korean study that found visceral adiposity to be a predictor of IBS symptoms and QoL, suggesting a potential link between metabolic health and IBS severity [ 12 ]. The higher prevalence of overweight/obesity in our cohort compared to European populations [ 13 , 14 ], highlights a regional health challenge that may compound the impact of IBS. Comorbidities such as diabetes (26%) and hypertension (24%) were also prevalent. Diabetes was associated with lower MCS and vitality scores [ 15 ], while hypertension was linked to reduced PCS, physical functioning, bodily pain, vitality, and overall QoL [ 16 ]. These chronic conditions often co-exist with IBS and can independently, or synergistically, contribute to a decline in overall health and well-being. Hypothyroidism, present in some patients, was associated with lower PCS, role physical, and overall QoL [ 17 ], further emphasizing the complex interplay of endocrine health with IBS symptoms and QoL. The predominant subtype of IBS in our study was IBS with constipation (IBS-C). This subtype was associated with lower MCS, vitality, mental health, social functioning, and overall QoL [ 18 ]. The chronic and often debilitating symptoms of IBS-C, including constant pain (reported by 100% of patients), constipation (65%), and bloating (63%), likely contribute significantly to this impairment. The presence of dolichocolon in 34% of patients, a condition characterized by an abnormally long colon, was associated with lower role emotional scores, suggesting a potential anatomical or physiological contributor to emotional distress in this subgroup. The practice of self-medication (18%) and the use of phytotherapy/homeopathy (36%) among our patients suggest a search for symptom relief beyond conventional medical approaches. While the study did not delve into the efficacy of these alternative treatments, their prevalence indicates a patient population actively seeking solutions, possibly due to dissatisfaction with conventional treatments or cultural preferences. The use of homeopathic/herbal treatment was associated with lower general health scores [ 19 ], which could imply that patients resorting to these methods might have more severe or persistent symptoms. Comparison with Existing Literature and Study Implications Our findings generally resonate with the broader literature on IBS [ 2 , 3 ], which consistently reports a significant reduction in QoL across various domains [ 20 – 24 ]. The observed gender disparity [ 22 ], the impact of socioeconomic factors [ 23 , 24 ], and the influence of comorbidities are well-established themes in IBS research. However, the higher average age of our cohort and the specific associations with regional health challenges like overweight/obesity and the prevalence of dolichocolon offer unique insights into the Tunisian context. The consistently lower SF-36 scores compared to the general Tunisian population [ 6 ], underscore the need for targeted interventions. The strong associations between impaired QoL and sociodemographic factors like age, gender, education, and SES highlight the importance of a holistic approach to patient care that extends beyond purely medical management. Addressing socioeconomic disparities, improving access to education, and providing support for employment could indirectly improve QoL in IBS patients. Clinically, the significant impact of comorbidities such as diabetes, hypertension, and hypothyroidism on QoL emphasizes the necessity of comprehensive management strategies that consider all co-existing conditions. For IBS-C patients, the findings reinforce the need for effective symptom management strategies, particularly for pain and constipation, which are major drivers of QoL impairment. The association of dolichocolon with emotional distress warrants further investigation into its physiological and psychological implications. The prevalence of alternative treatment seeking suggests a gap in conventional care or patient preferences that need to be understood and potentially integrated into a patient-centered approach. Future research could explore the perceived benefits and actual efficacy of these treatments in the Tunisian population. Study limits This study has several limitations. The sample size of 100 patients, while sufficient for identifying significant associations, may limit the generalizability of the findings to the entire Tunisian IBS population. The cross-sectional nature of the study prevents the establishment of causal relationships between the identified factors and QoL impairment. Furthermore, reliance on self-reported data for QoL assessment and some clinical parameters may introduce recall bias. The study also did not delve into the psychological comorbidities often associated with IBS, such as anxiety and depression, which are known to significantly impact QoL. Future longitudinal studies with larger cohorts and a broader assessment of psychological factors would provide a more comprehensive understanding of QoL in Tunisian IBS patients. Conclusion In conclusion, this study provides valuable insights into the quality of life and its associated factors in Tunisian patients with IBS. Our findings confirm that IBS significantly impairs QoL across physical and mental domains, with sociodemographic factors (age, gender, education, SES) and clinical factors (BMI, comorbidities, IBS subtype) playing crucial roles. These results emphasize the need for a multidisciplinary approach to IBS management in Tunisia, focusing on comprehensive patient assessment, addressing comorbidities, and considering the broader socioeconomic context to improve patient outcomes and overall well-being. Further research is warranted to explore the causal pathways and to develop culturally sensitive and effective interventions. Declarations Ethics approval and consent to participate: In accordance with Tunisian law and international recommendations, each university hospital is required to establish a "local committee for the protection of persons," which ensures strict adherence to ethical standards during the conduct of scientific studies involving hospital patients. For our study, approval was granted by the local committee for the protection of persons at Charles Nicole University Hospital in Tunis. All participants received detailed information about the study and provided written informed consent prior to enrollment. All participants provided written consent for publication of anonymized data included in this manuscript. Funding We declare that we received no specific funding for this work. Author Contribution M.S Y.Z wrote the main manuscript G.T elaborated the study protocole and did the statistical dataS.A and A.M prepared the figures and verified the referencesL.M reviewed the manuscript and the study protocol Data Availability The data that support the findings of this study can not be shared at this time due to legal and reasons to protect participant privacy. However, some data can be available from the corresponding author upon reasonable request. References Lovell RM, Ford AC. Global Prevalence of and Risk Factors for Irritable Bowel Syndrome: A Meta-analysis. Clin Gastroenterol Hepatol Jul. 2012;10(7):712–e7214. Meyiz H, Abid H, Mellouki I, Aqodad N, Benajah D, Abkari ME et al. Measurement and Determinants of Quality of Life in Patients with Functional Bowel Disorders.:8. Lee V, Guthrie E, Robinson A, KennedyA, Tomenson B, Rogers A, et al. Functional bowel disorders inprimarycare: factors associated with health-relatedqualityof life and doctor consultation. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8339769","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":598539754,"identity":"ebe36b2e-b633-4a4f-a212-69522ffe56f2","order_by":0,"name":"Yosra ZAIMI","email":"","orcid":"","institution":"Hôpital Charles-Nicolle","correspondingAuthor":false,"prefix":"","firstName":"Yosra","middleName":"","lastName":"ZAIMI","suffix":""},{"id":598539756,"identity":"623a8a1f-7d23-49cc-bf8e-efbcdae3252f","order_by":1,"name":"Maha SHIMI","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYFACHhBxgIeBmfnAB1K1sCXOYEgA8xkbiNECYhgSp0W3/ezBDwx/7sjotvN8bLr5gyFxv9gB9scFeLSYnclLlmBse8Zjdph3Y3NOAkNij3QCY/MMfFoO5BhIMDYcBmnZ/hiuhQeflvNvjH8w/AFp4XnYTJyWGzlmEgxsYC2MxGp5Y2aR2AbSwmbYnJMmYdxzO7FxNn6H5Rjf+PDnsL3Z+cNAh9nYyLbPTj7wGZ8WMEhAMCUYCMfkKBgFo2AUjAKCAADM8E5adRfvIgAAAABJRU5ErkJggg==","orcid":"","institution":"Military Hospital of Tunis","correspondingAuthor":true,"prefix":"","firstName":"Maha","middleName":"","lastName":"SHIMI","suffix":""},{"id":598539758,"identity":"22a5f772-c8cd-455a-ad3f-8a0e2c8a2895","order_by":2,"name":"Ghassen TRABELSI","email":"","orcid":"","institution":"Hôpital Charles-Nicolle","correspondingAuthor":false,"prefix":"","firstName":"Ghassen","middleName":"","lastName":"TRABELSI","suffix":""},{"id":598539760,"identity":"5be81035-4168-4d1a-ae62-80bf65e0dbcf","order_by":3,"name":"Shema AYADI","email":"","orcid":"","institution":"Hôpital Charles-Nicolle","correspondingAuthor":false,"prefix":"","firstName":"Shema","middleName":"","lastName":"AYADI","suffix":""},{"id":598539762,"identity":"5023247d-1c88-4773-a596-300d48f290f8","order_by":4,"name":"Asma MENSI","email":"","orcid":"","institution":"Hôpital Charles-Nicolle","correspondingAuthor":false,"prefix":"","firstName":"Asma","middleName":"","lastName":"MENSI","suffix":""},{"id":598539763,"identity":"76b5d457-02f8-45c1-b0d8-9b38ac1be3a1","order_by":5,"name":"Leila MOUELHI","email":"","orcid":"","institution":"Hôpital Charles-Nicolle","correspondingAuthor":false,"prefix":"","firstName":"Leila","middleName":"","lastName":"MOUELHI","suffix":""}],"badges":[],"createdAt":"2025-12-11 19:53:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8339769/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8339769/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104166792,"identity":"47216a99-8b00-49af-9855-e204531e1118","added_by":"auto","created_at":"2026-03-08 14:19:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":42848,"visible":true,"origin":"","legend":"\u003cp\u003ePhysical quality of life scores\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8339769/v1/e4bf52b6789fb71d1f2d1451.png"},{"id":104166793,"identity":"39535370-7a50-4d1e-8854-dae3931770e2","added_by":"auto","created_at":"2026-03-08 14:19:47","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":41088,"visible":true,"origin":"","legend":"\u003cp\u003ePsychological/mental quality of life score\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8339769/v1/fe7128d0004befd1a7bd041f.png"},{"id":104166794,"identity":"7f061f95-8e16-4eeb-b9b7-80f80d9c19d8","added_by":"auto","created_at":"2026-03-08 14:19:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":734967,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8339769/v1/1750ca68-00de-4f6c-b15e-44d828c95f54.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Quality of Life in Patients with Irritable Bowel Syndrome: A Cross-Sectional Study in Tunisia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eFunctional bowel disorders (FBDs), particularly Irritable Bowel Syndrome (IBS), represent a significant global health burden [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. IBS is characterized by chronic abdominal pain and altered bowel habits without identifiable organic abnormalities. Its prevalence is substantial, and it profoundly affects patients' daily lives, leading to reduced productivity, increased healthcare utilization, and impaired quality of life [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe diagnosis of FBDs, including IBS, is primarily clinical, relying on the Rome IV diagnostic criteria [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. These criteria define IBS by recurrent abdominal pain, on average at least one day per week for the past three months, associated with two or more of the following: relation to defecation, a change in stool frequency, or a change in stool shape/consistency. For a diagnosis of IBS, these symptoms must have been present for at least six months prior to diagnosis and during the last three months. IBS is further classified into subtypes based on stool consistency using the Bristol Stool Scale: constipation-predominant (IBS-C), diarrhea-predominant (IBS-D), mixed-type (IBS-M), and non-specific (IBS-U).\u003c/p\u003e \u003cp\u003eDespite the high prevalence and impact of IBS, there is a paucity of data specifically addressing the quality of life of IBS patients in Tunisia and the factors contributing to its impairment. This study aimed to fill this gap by measuring the quality of life in a cohort of Tunisian IBS patients and identifying the sociodemographic and clinical factors associated with its deterioration.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis was a prospective, single-center, cross-sectional study conducted in the outpatient department of the hepatogastroenterology service at Charles Nicole Hospital in Tunis. The study spanned one year, from February 2019 to January 2020.\u003c/p\u003e \u003cp\u003eInclusion criteria for participants were:\u003c/p\u003e \u003cp\u003e* Patients followed up at the hepatology and gastroenterology outpatient clinic.\u003c/p\u003e \u003cp\u003e* Patients meeting the Rome IV criteria for the diagnosis of irritable bowel syndrome.\u003c/p\u003e \u003cp\u003e* Patients who agreed to complete the questionnaire.\u003c/p\u003e \u003cp\u003eExclusion criteria included:\u003c/p\u003e \u003cp\u003e* Patients with comprehension difficulties.\u003c/p\u003e \u003cp\u003e* Patients who refused to complete the questionnaire.\u003c/p\u003e \u003cp\u003e* Patients with a neurological history.\u003c/p\u003e \u003cp\u003e* Patients with at least one missing answer on the questionnaire.\u003c/p\u003e \u003cp\u003eThe IBS subtype was specifically chosen for this study due to its high frequency and the clarity of its diagnostic criteria.\u003c/p\u003e \u003cp\u003eFor each included patient, a socio-demographic and clinical information form was completed by the senior physician or resident on duty. This form collected data on age, sex, medical and surgical history, level of education, socioeconomic status, main clinical signs, disease duration, and Body Mass Index (BMI). Patients were classified according to their BMI as follows: normal weight (BMI\u0026thinsp;\u0026lt;\u0026thinsp;25 kg/m\u0026sup2;), overweight (BMI between 25 and 30 kg/m\u0026sup2;), and obese (BMI\u0026thinsp;\u0026gt;\u0026thinsp;30 kg/m\u0026sup2;).\u003c/p\u003e \u003cp\u003eQuality of life was assessed using the Medical Outcome Study (MOS) Short Form 36 Health Survey (MOS SF-36 Health Survey), which was translated into Tunisian dialect [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The questionnaire was completed by the patients themselves whenever possible; for those with difficulties, assistance was provided by resident or intern physicians.\u003c/p\u003e \u003cp\u003eThe MOS SF-36 Health Survey, developed by Ware and Sherbourne in 1992, is a widely used health questionnaire applicable to individuals aged 14 and over [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. It measures eight dimensions of health: Physical Function, Role Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role Emotional, and Mental Health. Scores for each dimension range from 0 to 100, with higher scores indicating better health. These eight dimensions are further summarized into two global scores: the Physical Component Summary (PCS) and the Mental Component Summary (MCS), in addition to an overall SF-36 score.\u003c/p\u003e \u003cp\u003eDescriptive statistics were used to characterize the study population. Univariate analyses were performed to identify associations between sociodemographic and clinical parameters and the SF-36 scores (overall, PCS, and MCS).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThis study included 100 patients from the hepatology and gastroenterology department at Charles Nicolle Hospital in Tunis.\u003c/p\u003e\n\u003cp\u003eThe study population was predominantly female, with a male-to-female ratio of 0.53. The average age of patients was 50.53 years, ranging from 16 to 91 years, with a median age of 54 years. The majority of patients were between 35 and 65 years of age. The average age for women was lower than that for men (48.67 versus 53.45 years). Most patients (76%) were from the north of the country.\u003c/p\u003e\n\u003cp\u003eEducational levels were relatively evenly distributed, with a slight predominance of secondary education. Half of the patients were unemployed, and among the employed, most worked in the liberal sector. Socioeconomic status, assessed by monthly income, revealed that half of the patients had an income between 400 and 1,000 dinars (with the minimum wage being approximately 400 dinars). Most patients were married (66%), and the average number of children was 2.2.\u003c/p\u003e\n\u003cp\u003eRegarding clinical characteristics, he average Body Mass Index (BMI) of the patients was 27.53 kg/m\u0026sup2;, with a range of 19.03 to 44.12 kg/m\u0026sup2;. Thirty-five percent of patients were of normal weight, 40% were overweight, and the remaining 25% were considered obese.\u003c/p\u003e\n\u003cp\u003eMore than half of the patients had one or more comorbidities, predominantly diabetes (24%) and hypertension (26%). Hypothyroidism was present in 5% of patients. Sixteen percent had a history of surgery, mainly visceral and gynecological.\u003c/p\u003e\n\u003cp\u003ePain was a constant symptom among the patients. Constipation was the predominant bowel disorder, found in 65% of patients. Alternating diarrhea and constipation was noted in 11 patients. Based on Rome IV criteria, constipation-predominant IBS was the most common subtype (54%), followed by non-specific IBS (28%).\u003c/p\u003e\n\u003cp\u003ePatients followed up in the outpatient clinic were mainly referred from emergency departments (45%), while 55% were referred from local health centers or private practitioners. Eighteen percent of patients resorted to self-medication, mainly with antispasmodics and transit regulators. Additionally, 36% (N\u0026thinsp;=\u0026thinsp;36) used phytotherapy or homeopathic treatments, primarily herbal teas containing verbena, fennel seeds, and turmeric.\u003c/p\u003e\n\u003cp\u003eColonoscopy revealed dolichocolon in 34% of patients. Abdominal ultrasound showed hepatic steatosis in 21% of patients.\u003c/p\u003e\n\u003cp\u003eWhen it comes ti th Quality of Life Assessment (SF-36 Scores), the overall SF-36 score for our patients had a mean of 41.2% (median 41.6%), with scores ranging from 22.3% to 56%. The interquartile range (IQ 25\u0026ndash;75) was [35.8; 46.9].\u003c/p\u003e\n\u003cp\u003eThe Physical Component Summary (PCS) score, reflecting physical quality of life, had a mean of 42.5% (median 42.9%), with scores ranging from 22.8% to 57.3%. The IQ 25\u0026ndash;75 was [35.9; 49]. (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\n\u003cp\u003eThe Mental Component Summary (MCS) score, reflecting mental quality of life, had a mean of 39.9% (median 40.2%), with scores ranging from 21.8% to 54.8%. The IQ 25\u0026ndash;75 was [34.7; 45.6]. (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\n\u003cp\u003eAll physical and mental quality of life scores in our IBS patient cohort were significantly lower than those reported for the general Tunisian population.\u003c/p\u003e\n\u003cp\u003eThe reserch of factors Associated with Quality of Life Impairment identified several factors as being associated with impaired quality of life (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e) :\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eSummary table of significant associations with MOS SF-36 items\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"24%\"\u003e\n\u003cp\u003e\u003cstrong\u003eScore \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eparameter\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"5\" width=\"33%\"\u003e\n\u003cp\u003ePhysical quality of life\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"5\" width=\"33%\"\u003e\n\u003cp\u003eMental quality of life\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003eOverall\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003ePCS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003ePF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003eRP\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003eBP\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003eGH\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003eMCS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003eVT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003eRE\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003eMH\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003eSF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003eSF-36\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"24%\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026lt;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"24%\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,025\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,002\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,002\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e0,005\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,008\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e0,013\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,036\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0,003\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"24%\"\u003e\n\u003cp\u003eLev.education\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,003\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e0,017\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,005\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,007\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026lt;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0,011\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"24%\"\u003e\n\u003cp\u003eField of practice\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,009\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e0,047\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026lt;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0,005\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"24%\"\u003e\n\u003cp\u003eSES*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,016\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e0,04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e0,013\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,003\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,004\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e0,005\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,007\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e0,01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0,001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"24%\"\u003e\n\u003cp\u003eMarital Status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,028\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"24%\"\u003e\n\u003cp\u003eDiabetes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e0,008\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,021\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"24%\"\u003e\n\u003cp\u003eHypertension\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e0,014\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,042\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e0,032\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0,041\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"24%\"\u003e\n\u003cp\u003eHypothyroidism\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,037\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026lt;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,018\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0,034\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"24%\"\u003e\n\u003cp\u003eIBS-C**\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,019\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e0,01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e0,036\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,017\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0,049\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"24%\"\u003e\n\u003cp\u003eHomeopathy/phytotherapy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,031\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"24%\"\u003e\n\u003cp\u003eLong colon\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,019\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"24%\"\u003e\n\u003cp\u003eBMI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,003\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026lt;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,024\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0,012\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e0,045\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0,033\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* Socio-economic Status\u003c/p\u003e\n\u003cp\u003e** Irritable Bowel Syndrome with predominant constipation\u003c/p\u003e\n\u003cp\u003eValues represent p-values for statistically significant associations (p \u0026lt; 0.05). Empty cells indicate no statistically significant association was found for that parameter and SF-36 dimension\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eSummary of Significant Associations Between Sociodemographic/Clinical Factors and MOS SF-36 Health Survey Dimensions\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"181\"\u003e\n\u003cp\u003eParameter\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003ePhysical Component Summary (PCS)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003ePhysical Function (PF)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003eRole Physical (RP)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"58\"\u003e\n\u003cp\u003eBodily Pain (BP)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003eGeneral Health (GH)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003eMental Component Summary (MCS)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eVitality (VT)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003eRole Emotional (RE)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003e\u003cem\u003eMental Health (MH)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e\u003cem\u003eSocial Functioning (SF)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u003cem\u003eOverall SF-36\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"181\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026lt;10\u003csup\u003e-3\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"58\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"181\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e0.025\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"58\"\u003e\n\u003cp\u003e0.002\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e0.002\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e0.005\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e0.008\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003e0.013\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e0.036\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e0.003\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"181\"\u003e\n\u003cp\u003eLevel of Education\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e0.003\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e0.017\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"58\"\u003e\n\u003cp\u003e0.005\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e0.007\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026lt;10\u003csup\u003e-3\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e0.011\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"181\"\u003e\n\u003cp\u003eEmployment status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"58\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e0.009\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e0.047\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003e\u0026lt;1^{-3}\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e0.005\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"181\"\u003e\n\u003cp\u003eSocioeconomic Status (SES)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e0.016\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e0.013\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"58\"\u003e\n\u003cp\u003e0.003\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e0.004\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e0.005\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e0.007\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"181\"\u003e\n\u003cp\u003eMarital Status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"58\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e0.028\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"181\"\u003e\n\u003cp\u003eDiabetes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"58\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e0.008\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e0.021\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"181\"\u003e\n\u003cp\u003eHypertension\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e0.023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e0.014\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"58\"\u003e\n\u003cp\u003e0.042\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e0.032\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e0.041\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"181\"\u003e\n\u003cp\u003eHypothyroidism\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e0.037\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026lt;10\u003csup\u003e-3\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"58\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e0.018\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e0.034\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"181\"\u003e\n\u003cp\u003eIBS-C\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"58\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e0.019\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003e0.036\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e0.017\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e0.049\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"181\"\u003e\n\u003cp\u003eHomeopathic/Herbal Treatment\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"58\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e0.031\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"181\"\u003e\n\u003cp\u003eDolichocolon\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"58\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e0.019\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"181\"\u003e\n\u003cp\u003eBMI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e0.003\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026lt;10\u003csup\u003e-3\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"58\"\u003e\n\u003cp\u003e0.024\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e0.024\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e0.012\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e0.045\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e0.033\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Note: Values represent p-values for statistically significant associations (p \u0026lt; 0.05). Empty cells indicate no statistically significant association was found for that parameter and SF-36 dimension.\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePhysical health parameters (PCS and Physical Function) were inversely related to age (r=-0.348, p\u0026thinsp;=\u0026thinsp;0.002; r=-0.396, p\u0026thinsp;\u0026lt;\u0026thinsp;10^-3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMen generally had higher scores than women across most SF-36 items, with statistically significant differences for overall SF36, MCS, PCS, Role Emotional (RE), Social Functioning (SF), Mental Health (MH), Vitality (VT), and Bodily Pain (BP).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLow educational attainment was associated with impaired physical (PCS, Physical Function, Bodily Pain, General Health) and mental (Vitality) quality of life, as well as overall SF36.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEmployment Status\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUnemployed patients had the lowest average scores, while public sector employees had the best.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocioeconomic Status\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLow socioeconomic status was significantly associated with lower scores across almost all SF-36 items.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSingle patients had higher average scores, with a significant association for the MCS score.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eDiabetes: significantly affected psychological quality of life (Vitality, Social Functioning, MCS).\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eHypertension: significantly associated with lower physical (PCS, Physical Function, Bodily Pain), mental (Vitality), and overall (SF36) quality of life scores.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eHypothyroidism: Linked to lower overall SF36, physical (PCS, Role Physical, Bodily Pain), and mental (Role Emotional) quality of life scores.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eIBS Subtype: constipation-predominant IBS was significantly associated with lower mental quality of life scores (MCS, Social Functioning, Mental Health, Vitality) and overall SF-36.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eDolichocolon: significantly associated with the Role Emotional mental health score, and all scores were lower in patients with this feature.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eBody Mass Index (BMI): increased BMI was significantly associated with lower physical (General Health, Physical Function, PCS), mental (Vitality, MCS), and overall (SF36) quality of life scores.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to assess the quality of life (QoL) in patients with Irritable Bowel Syndrome (IBS) at the Hepatology and Gastroenterology Department of Charles Nicolle Hospital, Tunis, and to identify associated sociodemographic and clinical factors. Our findings, derived from a prospective study of 100 patients between February 2019 and January 2020, reveal significant insights into the multifaceted impact of IBS on patient well-being within a Tunisian context. The use of the MOS SF-36 questionnaire, translated and validated into Tunisian dialect [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], ensured cultural appropriateness and reliability in QoL assessment [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eSociodemographic Factors and Quality of Life\u003c/h3\u003e\n\u003cp\u003eOur study identified several sociodemographic factors significantly associated with impaired quality of life. A female predominance (65% of patients) was observed, consistent with global epidemiological trends in IBS [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], although the sex ratio (0.54) was less pronounced than in some Moroccan and Iranian studies (0.28 and 0.23 respectively) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This gender disparity is a consistent finding in IBS research, often attributed to hormonal factors, differences in pain perception, and healthcare-seeking behaviors.\u003c/p\u003e \u003cp\u003eThe average age of our cohort was 50.53 years, which is higher than reported averages in Algerian (41.8 years) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], Moroccan (44 years) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], and Iranian (30.8 years) studies [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This discrepancy could be indicative of delayed diagnosis or consultation patterns within the Tunisian healthcare system, where patients might resort to self-medication or alternative therapies before seeking specialized medical attention. This delay could lead to a more chronic and severe disease presentation by the time patients are included in studies, thus impacting their QoL more profoundly.\u003c/p\u003e \u003cp\u003eEducational attainment emerged as a significant factor, with lower educational levels being associated with poorer physical health (PCS) and overall QoL. Similarly, employment status, particularly unemployment or employment in the private sector, and lower socioeconomic status (SES) were consistently linked to reduced PCS, MCS, and overall SF-36 scores. These findings underscore the socioeconomic gradient in health outcomes, where limited resources, stressful work environments, and financial strain can exacerbate the physical and psychological burden of chronic conditions like IBS. The predominance of average incomes in our cohort, while seemingly contradictory to some meta-analyses on IBS prevalence across socioeconomic levels (1), might reflect the evolving landscape of private healthcare access in Tunisia, where individuals with some financial capacity might seek specialized care.\u003c/p\u003e \u003cp\u003eMarital status also played a role, with married individuals showing an association with lower MCS scores. This finding, while consistent with Japanese and British studies [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], regarding marital prevalence, warrants further investigation to understand the specific dynamics within marital relationships that might influence mental health in IBS patients [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eClinical Factors and Quality of Life\u003c/h3\u003e\n\u003cp\u003eSeveral clinical factors were found to significantly impact the quality of life in our IBS patient population. The high prevalence of overweight (40%) and obesity (25%), resulting in an average BMI of 27.53, is a notable finding. Overweight/obesity was associated with impaired PCS, MCS, and overall QoL. This aligns with a Korean study that found visceral adiposity to be a predictor of IBS symptoms and QoL, suggesting a potential link between metabolic health and IBS severity [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The higher prevalence of overweight/obesity in our cohort compared to European populations [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], highlights a regional health challenge that may compound the impact of IBS.\u003c/p\u003e \u003cp\u003eComorbidities such as diabetes (26%) and hypertension (24%) were also prevalent. Diabetes was associated with lower MCS and vitality scores [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], while hypertension was linked to reduced PCS, physical functioning, bodily pain, vitality, and overall QoL [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. These chronic conditions often co-exist with IBS and can independently, or synergistically, contribute to a decline in overall health and well-being. Hypothyroidism, present in some patients, was associated with lower PCS, role physical, and overall QoL [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], further emphasizing the complex interplay of endocrine health with IBS symptoms and QoL.\u003c/p\u003e \u003cp\u003eThe predominant subtype of IBS in our study was IBS with constipation (IBS-C). This subtype was associated with lower MCS, vitality, mental health, social functioning, and overall QoL [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The chronic and often debilitating symptoms of IBS-C, including constant pain (reported by 100% of patients), constipation (65%), and bloating (63%), likely contribute significantly to this impairment. The presence of dolichocolon in 34% of patients, a condition characterized by an abnormally long colon, was associated with lower role emotional scores, suggesting a potential anatomical or physiological contributor to emotional distress in this subgroup.\u003c/p\u003e \u003cp\u003eThe practice of self-medication (18%) and the use of phytotherapy/homeopathy (36%) among our patients suggest a search for symptom relief beyond conventional medical approaches. While the study did not delve into the efficacy of these alternative treatments, their prevalence indicates a patient population actively seeking solutions, possibly due to dissatisfaction with conventional treatments or cultural preferences. The use of homeopathic/herbal treatment was associated with lower general health scores [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], which could imply that patients resorting to these methods might have more severe or persistent symptoms.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eComparison with Existing Literature and Study Implications\u003c/h2\u003e \u003cp\u003eOur findings generally resonate with the broader literature on IBS [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], which consistently reports a significant reduction in QoL across various domains [\u003cspan additionalcitationids=\"CR21 CR22 CR23\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The observed gender disparity [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], the impact of socioeconomic factors [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], and the influence of comorbidities are well-established themes in IBS research. However, the higher average age of our cohort and the specific associations with regional health challenges like overweight/obesity and the prevalence of dolichocolon offer unique insights into the Tunisian context.\u003c/p\u003e \u003cp\u003eThe consistently lower SF-36 scores compared to the general Tunisian population [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], underscore the need for targeted interventions. The strong associations between impaired QoL and sociodemographic factors like age, gender, education, and SES highlight the importance of a holistic approach to patient care that extends beyond purely medical management. Addressing socioeconomic disparities, improving access to education, and providing support for employment could indirectly improve QoL in IBS patients.\u003c/p\u003e \u003cp\u003eClinically, the significant impact of comorbidities such as diabetes, hypertension, and hypothyroidism on QoL emphasizes the necessity of comprehensive management strategies that consider all co-existing conditions. For IBS-C patients, the findings reinforce the need for effective symptom management strategies, particularly for pain and constipation, which are major drivers of QoL impairment. The association of dolichocolon with emotional distress warrants further investigation into its physiological and psychological implications.\u003c/p\u003e \u003cp\u003eThe prevalence of alternative treatment seeking suggests a gap in conventional care or patient preferences that need to be understood and potentially integrated into a patient-centered approach. Future research could explore the perceived benefits and actual efficacy of these treatments in the Tunisian population.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy limits\u003c/h3\u003e\n\u003cp\u003eThis study has several limitations. The sample size of 100 patients, while sufficient for identifying significant associations, may limit the generalizability of the findings to the entire Tunisian IBS population. The cross-sectional nature of the study prevents the establishment of causal relationships between the identified factors and QoL impairment. Furthermore, reliance on self-reported data for QoL assessment and some clinical parameters may introduce recall bias. The study also did not delve into the psychological comorbidities often associated with IBS, such as anxiety and depression, which are known to significantly impact QoL. Future longitudinal studies with larger cohorts and a broader assessment of psychological factors would provide a more comprehensive understanding of QoL in Tunisian IBS patients.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this study provides valuable insights into the quality of life and its associated factors in Tunisian patients with IBS. Our findings confirm that IBS significantly impairs QoL across physical and mental domains, with sociodemographic factors (age, gender, education, SES) and clinical factors (BMI, comorbidities, IBS subtype) playing crucial roles. These results emphasize the need for a multidisciplinary approach to IBS management in Tunisia, focusing on comprehensive patient assessment, addressing comorbidities, and considering the broader socioeconomic context to improve patient outcomes and overall well-being. Further research is warranted to explore the causal pathways and to develop culturally sensitive and effective interventions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn accordance with Tunisian law and international recommendations, each university hospital is required to establish a \"local committee for the protection of persons,\" which ensures strict adherence to ethical standards during the conduct of scientific studies involving hospital patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor our study, approval was granted by the local committee for the protection of persons at Charles Nicole University Hospital in Tunis.\u003c/p\u003e\n\u003cp\u003eAll participants received detailed information about the study and provided written informed consent prior to enrollment.\u003c/p\u003e\n\u003cp\u003eAll participants provided written consent for publication of anonymized data included in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe declare that we received no specific funding for this work.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eM.S Y.Z wrote the main manuscript G.T elaborated the study protocole and did the statistical dataS.A and A.M prepared the figures and verified the referencesL.M reviewed the manuscript and the study protocol\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study can not be shared at this time due to legal and reasons to protect participant privacy. However, some data can be available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLovell RM, Ford AC. Global Prevalence of and Risk Factors for Irritable Bowel Syndrome: A Meta-analysis. Clin Gastroenterol Hepatol Jul. 2012;10(7):712\u0026ndash;e7214.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeyiz H, Abid H, Mellouki I, Aqodad N, Benajah D, Abkari ME et al. Measurement and Determinants of Quality of Life in Patients with Functional Bowel Disorders.:8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee V, Guthrie E, Robinson A, KennedyA, Tomenson B, Rogers A, et al. Functional bowel disorders inprimarycare: factors associated with health-relatedqualityof life and doctor consultation. J Psychosom Res. 2008;64(2):129\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchmulson MJ, Drossman DA. What Is New in Rome IV. J Neurogastroenterol Motil 30 Apr. 2017;23(2):151\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuermazi M, Allouch C, Yahia M, Huissa TBA, Ghorbel S, Damak J, et al. Translation into Arabic, adaptation and validation of the SF-36Health Survey for use in Tunisia. Ann Phys Rehabil Med Sept. 2012;55(6):388\u0026ndash;403.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWare JE, Sherbourne CD. The MOS 36-item short-form health survey(SF-36). I. Conceptual framework and item selection. Med Care June. 1992;30(6):473\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSi J-M, Wang L-J, Chen S-J, Sun L-M, Dai N. Irritable bowel syndrome consulters in Zhejiang province: The symptoms pattern, predominant bowel habit subgroups and quality of life. World J Gastroenterol 1 Apr. 2004;10(7):1059\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang YT, Lim HY, Tai D, Krishnamoorthy TL, Tan T, Barbier S, et al. The impact of Irritable Bowel Syndrome on health-related quality of life: a Singapore perspective. BMC Gastroenterol 9 August. 2012;12(1):104.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalem S, Malouche D, Ben Romdhane H. Tunisian population quality of life: a general analysis using SF-36. East Mediterr Health J. Sept. 12019;25(09):613-21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLongstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. 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Int J Psychiatry Med mai. 2018;53(3):159\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8339769/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8339769/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIrritable Bowel Syndrome (IBS) is a common functional bowel disorder significantly impacting patients' quality of life. This study aimed to assess the quality of life in Tunisian IBS patients and identify associated factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA prospective, single-center, cross-sectional study was conducted at Charles Nicole Hospital in Tunis from February 2019 to January 2020. One hundred patients meeting Rome IV criteria for IBS were included. Quality of life was assessed using the Medical Outcome Study Short Form 36 Health Survey (MOS SF-36), translated into Tunisian dialect. Sociodemographic and clinical data were also collected. Statistical analysis involved descriptive and univariate analyses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean age of participants was 50.53 years, with 65% being female. The overall SF-36 score was a mean of 41.2%, with Physical Component Summary (PCS) averaging 42.5% and Mental Component Summary (MCS) averaging 39.9%. All quality of life scores were significantly lower than those reported for the general Tunisian population. Factors associated with impaired quality of life included advanced age, female gender, low educational attainment, unemployment or private sector employment, low socioeconomic status, hypertension, hypothyroidism, overweight/obesity, diabetes, marital status, and constipation-predominant IBS. Specifically, constipation-predominant IBS (54% of cases) was associated with impaired mental quality of life.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIBS patients in Tunisia experience a significantly reduced quality of life across both physical and mental domains. Several modifiable sociodemographic and clinical factors contribute to this impairment. Addressing these factors through improved socioeconomic conditions, management of comorbidities, and psychological support could optimize patient care and improve their quality of life.\u003c/p\u003e","manuscriptTitle":"Quality of Life in Patients with Irritable Bowel Syndrome: A Cross-Sectional Study in Tunisia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-08 14:19:40","doi":"10.21203/rs.3.rs-8339769/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-03-17T06:29:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-14T13:14:19+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-04T09:56:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"278497282429527465215048395255407289304","date":"2026-03-04T09:33:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"131644880234921440222757662445113502247","date":"2026-03-04T09:05:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"279442431326735112665744196170816907064","date":"2026-03-04T05:52:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-28T12:58:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"97600557990227635587468104001106918700","date":"2026-02-27T08:05:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-25T06:16:12+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-02T09:59:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-17T09:16:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-16T21:18:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2025-12-16T21:13:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"074c74ac-06bb-4c8e-b8dd-1458402420c4","owner":[],"postedDate":"March 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-08T14:19:40+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-08 14:19:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8339769","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8339769","identity":"rs-8339769","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}