Prevalence and Factors Associated with Irritable Bowel Syndrome among Medical Students in Ethiopia: A Cross-Sectional Study

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Although global and regional studies suggest higher IBS prevalence among medical students, evidence from Ethiopia remains scarce. Objective To determine the prevalence and predictors of IBS among Ethiopian medical students. Methods A cross-sectional study was conducted from June to August 2024 among undergraduate medical students from 11 Ethiopian universities. Data were collected via a self-administered online questionnaire incorporating the Rome IV criteria for IBS diagnosis, lifestyle and health variables, and the Hospital Anxiety and Depression Scale (HADS). Binary logistic regression clustered by university was used to assess associations between IBS and selected predictors (sex, anxiety, depression). Universities with less than five participants were excluded in a sensitivity analysis. Results Of 290 participants, 20 (6.89%) met the Rome IV criteria for IBS. Anxiety was significantly associated with IBS (OR = 7.25; 95% CI: 2.45–21.43; p < 0.001), while no significant associations were found with sex, depression, or borderline anxiety/depression. A sensitivity analysis excluding universities with less than five participants similarly showed significant association with anxiety. The final model showed acceptable discrimination (AUC = 0.776). Conclusion IBS prevalence among Ethiopian medical students was lower than previously reported locally and internationally, possibly due to the use of stricter diagnostic criteria and contextual factors. Anxiety emerged as a key associated factor, underscoring the need for psychosocial support within medical training programs. Larger, longitudinal studies are warranted to explore additional risk factors and inform targeted interventions. Irritable Bowel Syndrome Medical Students Ethiopia Anxiety Rome IV Cross-Sectional Study Figures Figure 1 Introduction Irritable bowel syndrome (IBS) is among the disorders of gut-brain interaction (also known as functional disorders of the gastrointestinal system) manifesting with episodic pain and altered bowel habits with no detectable evidence of structural abnormality of the gastrointestinal tract (GIT) ( 1 , 2 ). IBS is formally defined using the Rome IV criteria as history of recurrent abdominal pain that occurs at least one day a week (on average) in the last 3 months, associated with at least two of the following: pain related to defecation, a change in the frequency of stool, or a change in the appearance of stool. The symptoms must have started at least 6 months before diagnosis for IBS to be defined ( 3 ). Although not fatal, IBS reduces the health-related quality of life (HRQoL) of patients more than chronic systemic diseases such as diabetes mellitus and end-stage renal failure. Its economic and psychological impacts are also far-reaching ( 4 ). IBS has no cure, but its symptoms are treatable with a combination of lifestyle, dietary and pharmacologic methods ( 5 ). To date, multiple mechanisms have been proposed to be involved in the pathogenesis of IBS, including altered gastrointestinal motility, visceral hypersensitivity, postinfectious reactivity, brain-gut interactions, alterations in the gut microbiota, bacterial overgrowth, food sensitivity, carbohydrate malabsorption, intestinal inflammation, secretory dysfunctions, and somatic and psychiatric comorbidities ( 2 ). Although the interaction between these factors remains poorly understood, numerous studies have identified consistent risk factors associated with an increased prevalence of IBS. These risk factors include female sex, socioeconomic status, ethnicity, family history of IBS, smoking, history of gastrointestinal infection, consumption of canned food or fast food, anxiety, depression, psychological stress ( 2 , 6 – 14 ). Information on the worldwide prevalence of IBS is scarce. The few studies on this topic have used different criteria to define IBS in participants, which has led to a wide discrepancy in the results of the studies compared with one another ( 2 ). For example, studies that used the Rome III criteria reported a significantly higher worldwide prevalence of 10.1% than those that used the Rome IV criteria, which reported a prevalence of 3.8% ( 2 , 4 ). However, studies indicate significantly higher rates of IBS prevalence in medical students worldwide, ranging from 9.3–35.5%. Studies from low- and middle-income countries, including Egypt, Nigeria, Benin, and Tunisia, reported that the prevalence of IBS among medical students ranged from 7.6–30% ( 13 – 17 ). These studies revealed varied associations with sex, diet, and psychological factors, highlighting inconsistencies in IBS patterns across different African populations. Despite the apparent burden, to our knowledge, a study on the prevalence rate of irritable bowel syndrome in Ethiopia has not yet been conducted. Additionally, aside from a recently published study that evaluated the prevalence of IBS among clinical students at a single university in Ethiopia ( 18 ), there is little research on the prevalence of IBS at the national level. Moreover, information on the predictors of IBS in Ethiopian medical students is not available. This represents a significant gap in both clinical knowledge and policy-relevant data. Given the potential impact of IBS on academic performance, mental well-being, and long-term career functioning among future healthcare professionals, identifying the predictors and addressing this issue is critical. Objectives This study therefore aims to do the following: Determine the prevalence rate of IBS in Ethiopian medical students and Determine the predictors of IBS in Ethiopian medical students. Methods Study Design and Setting This was a cross-sectional analytical study conducted among undergraduate medical students from eight universities in Ethiopia. A self-administered online questionnaire was prepared in English on Google Forms, and its link (URL) was distributed to official social media groups of all cohorts of medical students from June 1 - August 31, 2024, in the medical schools mentioned above. Written consent was taken from each participant at the beginning of the form after explanation of the research and its purposes. Participants Participants were undergraduate medical students from several public and private medical colleges. Students were eligible if they were currently enrolled in any year of their university’s undergraduate medical program and provided informed consent. The exclusion criteria were the presence of bloody stools in the past 6 months and history of colon cancer in self or a first-degree relative. The exclusion criteria were embedded in the Google Form, and the Google Form automatically excluded participants who possessed these criteria. Variables The primary outcome variable was the presence or absence of irritable bowel syndrome , as determined by the Rome IV IBS questions embedded in the survey. The independent variables were all categorical and included ( 1 ) demographic factors: sex (male/female), age group (≤ 20, 21–30, > 30), marital status (unmarried/married), and year of study (Years I to IV and internship year). ( 2 ) Lifestyle behaviors: alcohol use (yes/never), smoking (yes/never), physical activity (yes/never), fast food consumption (yes/never), and sleep quality (< 7 hours, ≥ 7 hours). ( 3 ) Health indicators: family history of IBS (yes/no), presence of allergies (yes/no), chronic illness (yes/no), GPA category (< 3.5 vs 3.5-4.0), and accommodation (dormitory/with family/off-campus away from family). ( 4 ) Psychological factors: anxiety and depression symptoms were determined via the Hospital Anxiety and Depression Scale (HADS). The HADS is a questionnaire that includes 14 questions. Seven of these scales are used to assess depression, whereas the remaining seven assess anxiety. The answers to each question are ranked on a scale of 0–3, and the ranks of all the replies are added to obtain a total score for anxiety and depression. The total score is then categorized as “normal”, “borderline abnormal” or “case of anxiety/depression” if the total score is 0–7, 8–10 or 11–21, respectively. ( 19 , 20 ) The levels of all variables were derived from clinically relevant cutoffs. Data Sources and Measurement Data were collected through a self-administered questionnaire, which included standardized questions on IBS symptoms, lifestyle habits, and mental health. Where possible, questions were adapted from validated tools. Prior to the main data collection, a pilot test was conducted on 17 students to ensure clarity and face validity. Study size A total of 288 students were planned to be included. The sample size was calculated via the following formula: n = (Zα/2)2 p(1-p)/d2 where n = sample size, Zα/2 = Z value at (α = 0.05) = 1.96, p = prevalence = 23% (estimated from the study conducted at the University of Gondar.) ( 18 )The proportion of nonoccurrence events to be studied was calculated as follows: 1-p = 1-0.23 = 0.77 d = margin of error (precision) = 0.05. A non-response rate of 5% was expected, resulting in a minimum sample size of 288. Bias To minimize selection bias, students were recruited from multiple academic years and across different universities. Moreover, designated investigators at each institution actively encouraged participation, aiming to reduce the risk of preferential response from individuals with heightened health awareness or preexisting IBS symptoms. Statistical methods All analyses were performed via R version 4.4.1. Frequencies and percentages were used to describe participant characteristics and IBS prevalence. The variables are summarized overall and by IBS status, as shown in the table below. Binary logistic regression was used to examine the relationships between IBS status (dependent variable) and the independent variables. A regression model clustered by participants’ universities was used to determine the predictors of IBS among the independent variables. Given the relatively small number of IBS cases reported in previous studies, including a large set of predictors in our model would have risked overfitting if case numbers were similarly low in this study. Therefore, drawing on prior evidence that consistently demonstrated strong associations between depression, anxiety, sex, and IBS among medical students in other countries ( 21 , 22 ), only these three variables were included as independent predictors in the regression model, although all variables were examined descriptively. Odds ratios (ORs), 95% confidence intervals (CIs), and p-values were calculated. Sensitivity analysis Because several universities contributed relatively small numbers of respondents, we conducted a sensitivity analysis excluding universities with fewer than five participants. The threshold of five was chosen to retain smaller medical schools (which often have fewer enrolled students) while avoiding undue influence from extremely small clusters; a higher cutoff would likely have excluded a disproportionate number of smaller universities. Model estimates were compared with the main analysis to assess robustness. Model Performance and Evaluation To assess model performance, predicted probabilities from the final logistic model were used to generate a receiver operating characteristic (ROC) curve, as was done in other studies investigating predictors of a condition ( 23 ). The area under the ROC curve (AUC) was calculated via the pROC package to quantify model discrimination. An AUC > 0.7 was considered acceptable, as recommended in the literature ( 24 ). Handling of Missing Data The final dataset contained no missing data on the included variables, as the submission of the questionnaires was completed once a participant finished all the questions and submitted them. Therefore, no imputation or exclusion procedures were needed. Ethical considerations This study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from Addis Ababa University Internal Medicine Department Review Board, and informed consent was obtained from all participants prior to data collection. Results A total of 290 university students participated in the study (completed the questionnaire). Among these students, 20 (6.9%) met the criteria for irritable bowel syndrome (IBS), whereas 270 (93.1%) did not. Baseline characteristics Table 1 outlines the baseline characteristics of the sample by IBS status. Among the participants without IBS, 104 (38.5%) were male, and 166 (61.5%) were female; among those with IBS, 4 (20.0%) were male, and 16 (80.0%) were female. The majority of participants were aged between 21–30 years, comprising 207 (76.7%) in the non-IBS group and 17 (85.0%) in the IBS group. Overall, only 5 participants were aged over 30 years, none of whom had IBS. Students from all eight universities participated, but Addis Ababa University had a plurality, making up 41% of the non-IBS group and 45% of the IBS group. There were three universities with less than 5 participants in the study (Ambo University, Mizan Tepi University, and Wachamo University). A family history of IBS was present in 19 (7.0%) non-IBS participants and 4 (20.0%) IBS participants. Anxiety was reported as “present” by 72 non-IBS (26.7%) and 13 IBS (65.0%) participants, whereas “borderline” anxiety was reported by 51 and 3 participants, respectively. For depression, 48 non-IBS (17.8%) and 4 IBS (20.0%) participants reported it as “present,” and 47 non-IBS (17.4%) and 8 IBS (40.0%) reported it as “borderline.” Allergies were reported in 30 (11.1%) patients in the non-IBS group and in 6 (30.0%) patients in the IBS group. GPAs of 3.5–4.0 were reported by 133 (49.3%) non-IBS participants and 8 (40.0%) IBS participants. Chronic illness was uncommonly reported by 28 non-IBS (10.4%) and 4 IBS (20.0%) participants. In terms of accommodation, most students lived in dormitories (161 non-IBS [59.6%], 9 IBS [45.0%]). In terms of lifestyle, 168 (62.2%) non-IBS and 15 (75.0%) IBS participants had never consumed alcohol, and 260 (96.3%) and 19 (95.0%) had never smoked cigarettes, respectively. Regular exercise was reported by only 27 non-IBSs (10.0%) and 1 participant with IBS (5.0%). The consumption of fast food was more common in the non-IBS group (57 [21.1%]) than in the IBS group (3 [15.0%]). Regarding sleep, 157 (58.1%) non-IBS participants and 9 (45.0%) IBS participants reported sleeping fewer than seven hours per night. Inferential analysis A binary logistic regression model clustered by university status was used to examine the associations among depression, anxiety, sex, and IBS. Depression and anxiety categories were classified according to the Hospital Anxiety and Depression Scale (HADS) score as normal, borderline, or case (of anxiety or depression). Anxiety was significantly associated with increased odds of IBS when participants classified as having anxiety were compared with those classified as normal (OR = 7.25; 95% CI: 2.45–21.43; p < 0.001). No statistically significant associations were detected for borderline anxiety (OR = 1.80; 95% CI: 0.55–5.95; p = 0.332), borderline depression (OR = 1.77; 95% CI: 0.47–6.73; p = 0.400), depression (OR = 0.47; 95% CI: 0.16–1.38; p = 0.167), or female sex (OR = 1.67; 95% CI: 0.70–3.97; p = 0.244). Table 2 presents the full results of the logistic regression analysis. These findings suggest that, among the predictors examined, only anxiety showed a statistically significant association with IBS incidence in this sample. Table 2 Logistic regression results for predictors of IBS, with standard errors clustered by university. Depression and anxiety categories were classified according to the Hospital Anxiety and Depression Scale (HADS) as normal, borderline, or case.CI refers to confidence interval. Variable Category Adjusted OR ‡ 95% CI p-value Depression † Borderline depression 1.77 (0.47, 6.73) 0.40 Depression (case) 0.47 (0.16, 1.38) 0.17 Anxiety † Borderline Anxiety 1.80 (0.55, 5.95) 0.33 Anxiety (case) 7.25 (2.45, 21.43) < 0.01 * Sex Female (vs Male) 1.67 (0.70, 3.97) 0.24 *Statistically significant p-values (< 0.05) are indicated with an asterisk (*). † Reference categories were participants without depression and participants without anxiety for depression and anxiety, respectively. ‡ Adjusted for clustering by university. Sensitivity analysis Excluding universities with < 5 respondents produced very similar estimates: anxiety remained strongly associated with IBS (OR 7.12, 95% CI 2.33–21.72; p < 0.01), while borderline depression (OR 1.84, 95% CI 0.56–5.98; p = 0.31); depression (OR 0.46, 95% CI 0.15–1.38; p = 0.17) and female sex (OR 1.61, 95% CI 0.68–3.80; p = 0.28) remained non‑significant. The central finding of a strong association between anxiety and IBS was robust in a sensitivity analysis that removed universities with fewer than five respondents, with effect sizes closely mirroring the primary model. This consistency suggests that including the three small university clusters did not significantly affect the results. Model evaluation The area under the receiver operating characteristic (ROC) curve for the final logistic regression model was 0.776, indicating acceptable discriminative ability in identifying individuals with IBS. The predictors in this model were depression, anxiety, and sex, as described in the Statistical Methods section. Figure 1 shows the ROC curve for this model, illustrating the trade-off between sensitivity and specificity across classification thresholds. Discussion This study assessed the prevalence and associated factors of irritable bowel syndrome (IBS) among Ethiopian medical students, a group known to be at elevated risk for stress-related disorders. The impetus for this research was the limited evidence on IBS in sub-Saharan African medical student populations, despite their unique academic and psychosocial stressors. Our findings indicate a prevalence of IBS of 6.89% among Ethiopian medical students, which is considerably lower than that reported in a previous study among Gondar University medical students (23%)( 25 ). This difference may be attributed to several factors. First, the current study used the Rome IV criteria, which are more stringent and generally yield lower prevalence rates than previous criteria. Additionally, differences in participant demographics, environmental stressors, or academic workload may have contributed to the lower prevalence observed in our cohort. Consistent with global evidence, we found a significant association between IBS and anxiety, underscoring the role of psychosocial factors in the pathophysiology of IBS among university students. This aligns with prior research, which identified emotional stress and anxiety as important risk factors for IBS( 10 , 25 , 26 ). The lack of significant associations between IBS and borderline anxiety, depression, or borderline depression in our sample may be due to the relatively small number of students with IBS, limiting the statistical power to detect such relationships. Alternatively, cultural or contextual factors may modulate how stress and mental health symptoms are expressed and reported in this population. Unlike findings from Western populations where IBS is more prevalent among females, our study did not demonstrate a significant difference between the sexes. This pattern is consistent with studies from Africa and parts of Asia, suggesting that the sex distribution of IBS may be influenced by genetic, environmental, or sociocultural factors specific to different regions ( 27 ). The associations between IBS and other known risk factors, such as dietary habits, socioeconomic status, and family history, were not statistically significant in this study, possibly reflecting the relatively homogenous lifestyle and dietary patterns among Ethiopian medical students or the insufficient sample size to detect these associations ( 27 ). Studies performed in most parts of the world, in low-, middle-, and high-income countries, report an increased rate of IBS in medical students compared with the rest of the population ( 28 – 32 ). While our prevalence was lower than that in many international reports, the observed association with anxiety is in line with the established literature. This finding highlights the need for ongoing mental health support and targeted interventions within medical training environments. On the African continent, studies on IBS in medical students reported a similarly high prevalence as that reported in the rest of the world ( 2 , 13 – 15 , 17 ). This study has many strengths. It is the first multicenter study on the prevalence and predictors of irritable bowel syndrome among Ethiopian medical students, to the best of our knowledge. This therefore fills a significant data gap in Ethiopia and Sub-Saharan Africa. Another notable strength of this study is the use of internationally accredited diagnostic criteria and psychological assessment tools, namely Rome IV and HADS, which further strengthen the reliability of the findings. Additionally, the diversity of participants in the year of medical education and university location makes the sample more representative. Despite these strengths, some limitations should be acknowledged. The number of IBS cases was relatively modest; however, it was sufficient to detect meaningful relationships (particularly with anxiety). Although participation was voluntary, possibly introducing a modest risk of self-selection bias (including healthy volunteer bias), this was likely offset by the neutral distribution platform and efforts by investigators at each university to broadly encourage student participation. In conclusion, IBS is present among Ethiopian medical students, with anxiety emerging as a significant associated factor. The lower prevalence observed compared with that reported in previous local and international studies may reflect methodological and contextual differences. These findings underscore the importance of integrating psychosocial support into medical education to address both mental health and gastrointestinal symptoms among students. We believe that there is a strong need for multicenter and longitudinal research to clarify risk factors and develop effective preventive strategies in this population. Conclusion Given its prevalence and impact on quality of life, relatively few data on the epidemiology and risk factors for IBS at both the global and regional levels exist. Our findings highlight the potential influence of psychological factors on IBS among medical students in Ethiopia. However, the limited number of IBS patients in our sample may have reduced the statistical power to detect other associations. Further studies with larger and more diverse cohorts are recommended to better understand the psychosocial correlates of IBS in the medical student population. Abbreviations AUC Area under the curve CI Confidence interval HADS Hospital Anxiety and Depression Scale HRQoL health-related quality of life IBS Inflammatory bowel syndrome OR Odds ratio URL Uniform Resource Locator Declarations Conflicts of interest : No conflicts of interest are declared. Acknowledgments: We would like to extend our appreciation to the International Institute for Primary Health Care, Ethiopia and Professor Getu Degu from Bahir Dar University for their constant guidance throughout the preparation of this manuscript. In addition, we would like to thank representatives at each participating university who encouraged students to participate in the research, especially Hawi Baye, Abigya Solomon Demeke, Tony Tsegaye, Kaleb Y. Tsega, Yordanos Dereje. Financing : We have not received any funding for this manuscript. Data availability statement : The data collected and analyzed in this study are available from the corresponding author on reasonable request. Ethics Approval : We received ethical approval from the Addis Ababa University Internal Medicine Department Review Board. Consent for publication : Not applicable Clinical trial number: Not applicable The final manuscript has been read by all the coauthors. The final manuscript has been approved for final submission by all the coauthors. Authors’ Role Elias Tafesse Yeshitila: Conceptualization, Project administration All authors : Data collection, review, compilation and synthesis. Nanati Jemal Aliye: Reviewed and edited the first draft Abdulsemed Mohammed Nur : Reviewed the first draft. Mengistu Yilma : Reviewed the second draft. Elias Taffesse Yeshitila: Reviewed and edited the second draft All authors : Wrote the manuscript Final approval of manuscript : All authors Table 1. was designed by Elias Tafesse Yeshitila 1,2 , Table 2. was designed by Elias Tafesse Yeshitila 1,2 , Figure 1. was designed by Elias Tafesse Yeshitila 1,2 , References A D. 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Supplementary Files SupplementaryMaterial.docx Table1Baselinecharacteristics.docx Cite Share Download PDF Status: Published Journal Publication published 26 Nov, 2025 Read the published version in BMC Gastroenterology → Version 1 posted Editorial decision: Revision requested 29 Sep, 2025 Reviews received at journal 28 Sep, 2025 Reviewers agreed at journal 28 Sep, 2025 Reviews received at journal 28 Sep, 2025 Reviewers agreed at journal 27 Sep, 2025 Reviewers invited by journal 17 Sep, 2025 Editor assigned by journal 16 Sep, 2025 Editor invited by journal 29 Aug, 2025 Submission checks completed at journal 27 Aug, 2025 First submitted to journal 27 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Yeshitila","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxUlEQVRIiWNgGAWjYFAC5uM/EirgvARitLAlSHw4Q5oWHgPJmW2kaOGXSDAw5p1nJ6/bwPzwA2NbGmEtkjMSEpJ5tyUbbjvAZizB2JZDWIvBjYQDh3m3HWDcdoDBjIGxrYKwFvsbiY3NvHMO2G87wP6NOC0GEsnMjDMbDiRuO8ADsoUIh0mcecbG8OFYcvK2wzzFEgnniPA+f3v+N4aEGjvbbcfbN374UJZMWAuDQAKUwcxAZEQy8B8gStkoGAWjYBSMZAAALXo5RDGn9LMAAAAASUVORK5CYII=","orcid":"","institution":"Addis Ababa University","correspondingAuthor":true,"prefix":"","firstName":"Elias","middleName":"Tafesse","lastName":"Yeshitila","suffix":""},{"id":517129776,"identity":"8ee25136-1210-4032-9585-52647b4c0da3","order_by":1,"name":"Nanati Jemal Aliye","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Nanati","middleName":"Jemal","lastName":"Aliye","suffix":""},{"id":517129777,"identity":"d760c983-9921-4709-aeff-f555d6f7be12","order_by":2,"name":"Abdulsemed Mohammed Nur","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Abdulsemed","middleName":"Mohammed","lastName":"Nur","suffix":""},{"id":517129779,"identity":"d610d527-4a33-4a7b-86ad-872187e98b54","order_by":3,"name":"Mengistu Yilma","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Mengistu","middleName":"","lastName":"Yilma","suffix":""}],"badges":[],"createdAt":"2025-08-18 16:53:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7401772/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7401772/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12876-025-04415-8","type":"published","date":"2025-11-26T15:57:58+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":92471326,"identity":"676daae1-7826-49f6-ad63-3ec0f68eca80","added_by":"auto","created_at":"2025-09-30 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06:49:24","extension":"xml","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":110621,"visible":true,"origin":"","legend":"","description":"","filename":"f60e617e07bd492597dc1a519840ccb31structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7401772/v1/56d31028cd274f2d3e5936af.xml"},{"id":92471334,"identity":"b6854057-f3d1-4c5b-b72b-61d8a44765d3","added_by":"auto","created_at":"2025-09-30 06:49:24","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":121395,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7401772/v1/5fae0f3b18c3bf4168dcfa77.html"},{"id":92473050,"identity":"5677265d-4cf5-4009-9aa9-d30cd0a5dbb0","added_by":"auto","created_at":"2025-09-30 06:57:23","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":38428,"visible":true,"origin":"","legend":"\u003cp\u003eReceiver operating characteristic (ROC) curve for the logistic regression model predicting IBS from depression, anxiety, and sex, with standard errors clustered by university (AUC = 0.776). The x-axis is inverted (from 1.0 to 0.0), showing 1-specificity.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7401772/v1/71edbed8c4481bb6ef0e27da.png"},{"id":97179388,"identity":"1c5990aa-74e7-4dc3-8997-1e2d721e8db8","added_by":"auto","created_at":"2025-12-01 16:15:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":643175,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7401772/v1/a8d1e06d-387c-4cea-a7cf-0dee3a49668d.pdf"},{"id":92471325,"identity":"e732dd5a-fa69-4fb6-be10-87248b1c9d45","added_by":"auto","created_at":"2025-09-30 06:49:23","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":7675,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-7401772/v1/d6350726534bcb47bece97e9.docx"},{"id":92471328,"identity":"87202308-3d77-485f-9fe8-3d35952f2ee8","added_by":"auto","created_at":"2025-09-30 06:49:23","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":23979,"visible":true,"origin":"","legend":"","description":"","filename":"Table1Baselinecharacteristics.docx","url":"https://assets-eu.researchsquare.com/files/rs-7401772/v1/5bcd3d80e618ffc899c1342d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and Factors Associated with Irritable Bowel Syndrome among Medical Students in Ethiopia: A Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIrritable bowel syndrome (IBS) is among the disorders of gut-brain interaction (also known as functional disorders of the gastrointestinal system) manifesting with episodic pain and altered bowel habits with no detectable evidence of structural abnormality of the gastrointestinal tract (GIT) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIBS is formally defined using the Rome IV criteria as history of recurrent abdominal pain that occurs at least one day a week (on average) in the last 3 months, associated with at least two of the following: pain related to defecation, a change in the frequency of stool, or a change in the appearance of stool. The symptoms must have started at least 6 months before diagnosis for IBS to be defined (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlthough not fatal, IBS reduces the health-related quality of life (HRQoL) of patients more than chronic systemic diseases such as diabetes mellitus and end-stage renal failure. Its economic and psychological impacts are also far-reaching (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). IBS has no cure, but its symptoms are treatable with a combination of lifestyle, dietary and pharmacologic methods (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTo date, multiple mechanisms have been proposed to be involved in the pathogenesis of IBS, including altered gastrointestinal motility, visceral hypersensitivity, postinfectious reactivity, brain-gut interactions, alterations in the gut microbiota, bacterial overgrowth, food sensitivity, carbohydrate malabsorption, intestinal inflammation, secretory dysfunctions, and somatic and psychiatric comorbidities (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Although the interaction between these factors remains poorly understood, numerous studies have identified consistent risk factors associated with an increased prevalence of IBS. These risk factors include female sex, socioeconomic status, ethnicity, family history of IBS, smoking, history of gastrointestinal infection, consumption of canned food or fast food, anxiety, depression, psychological stress (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR7 CR8 CR9 CR10 CR11 CR12 CR13\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eInformation on the worldwide prevalence of IBS is scarce. The few studies on this topic have used different criteria to define IBS in participants, which has led to a wide discrepancy in the results of the studies compared with one another (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). For example, studies that used the Rome III criteria reported a significantly higher worldwide prevalence of 10.1% than those that used the Rome IV criteria, which reported a prevalence of 3.8% (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHowever, studies indicate significantly higher rates of IBS prevalence in medical students worldwide, ranging from 9.3\u0026ndash;35.5%. Studies from low- and middle-income countries, including Egypt, Nigeria, Benin, and Tunisia, reported that the prevalence of IBS among medical students ranged from 7.6\u0026ndash;30% (\u003cspan additionalcitationids=\"CR14 CR15 CR16\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). These studies revealed varied associations with sex, diet, and psychological factors, highlighting inconsistencies in IBS patterns across different African populations.\u003c/p\u003e\u003cp\u003eDespite the apparent burden, to our knowledge, a study on the prevalence rate of irritable bowel syndrome in Ethiopia has not yet been conducted. Additionally, aside from a recently published study that evaluated the prevalence of IBS among clinical students at a single university in Ethiopia (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), there is little research on the prevalence of IBS at the national level. Moreover, information on the predictors of IBS in Ethiopian medical students is not available. This represents a significant gap in both clinical knowledge and policy-relevant data. Given the potential impact of IBS on academic performance, mental well-being, and long-term career functioning among future healthcare professionals, identifying the predictors and addressing this issue is critical.\u003c/p\u003e\u003cp\u003eObjectives\u003c/p\u003e\u003cp\u003eThis study therefore aims to do the following:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eDetermine the prevalence rate of IBS in Ethiopian medical students and\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eDetermine the predictors of IBS in Ethiopian medical students.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy Design and Setting\u003c/p\u003e\u003cp\u003eThis was a cross-sectional analytical study conducted among undergraduate medical students from eight universities in Ethiopia. A self-administered online questionnaire was prepared in English on Google Forms, and its link (URL) was distributed to official social media groups of all cohorts of medical students from June 1 - August 31, 2024, in the medical schools mentioned above. Written consent was taken from each participant at the beginning of the form after explanation of the research and its purposes.\u003c/p\u003e\u003cp\u003eParticipants\u003c/p\u003e\u003cp\u003eParticipants were undergraduate medical students from several public and private medical colleges. Students were eligible if they were currently enrolled in any year of their university\u0026rsquo;s undergraduate medical program and provided informed consent.\u003c/p\u003e\u003cp\u003eThe exclusion criteria were the presence of bloody stools in the past 6 months and history of colon cancer in self or a first-degree relative. The exclusion criteria were embedded in the Google Form, and the Google Form automatically excluded participants who possessed these criteria.\u003c/p\u003e\u003cp\u003eVariables\u003c/p\u003e\u003cp\u003eThe primary outcome variable was \u003cem\u003ethe presence or absence of irritable bowel syndrome\u003c/em\u003e, as determined by the Rome IV IBS questions embedded in the survey.\u003c/p\u003e\u003cp\u003eThe independent variables were all categorical and included (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) demographic factors: sex (male/female), age group (\u0026le;\u0026thinsp;20, 21\u0026ndash;30, \u0026gt;\u0026thinsp;30), marital status (unmarried/married), and year of study (Years I to IV and internship year). (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Lifestyle behaviors: alcohol use (yes/never), smoking (yes/never), physical activity (yes/never), fast food consumption (yes/never), and sleep quality (\u0026lt;\u0026thinsp;7 hours, \u0026ge;\u0026thinsp;7 hours). (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Health indicators: family history of IBS (yes/no), presence of allergies (yes/no), chronic illness (yes/no), GPA category (\u0026lt;\u0026thinsp;3.5 vs 3.5-4.0), and accommodation (dormitory/with family/off-campus away from family). (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) Psychological factors: anxiety and depression symptoms were determined via the Hospital Anxiety and Depression Scale (HADS). The HADS is a questionnaire that includes 14 questions. Seven of these scales are used to assess depression, whereas the remaining seven assess anxiety. The answers to each question are ranked on a scale of 0\u0026ndash;3, and the ranks of all the replies are added to obtain a total score for anxiety and depression. The total score is then categorized as \u0026ldquo;normal\u0026rdquo;, \u0026ldquo;borderline abnormal\u0026rdquo; or \u0026ldquo;case of anxiety/depression\u0026rdquo; if the total score is 0\u0026ndash;7, 8\u0026ndash;10 or 11\u0026ndash;21, respectively. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThe levels of all variables were derived from clinically relevant cutoffs.\u003c/p\u003e\u003cp\u003eData Sources and Measurement\u003c/p\u003e\u003cp\u003eData were collected through a self-administered questionnaire, which included standardized questions on IBS symptoms, lifestyle habits, and mental health. Where possible, questions were adapted from validated tools. Prior to the main data collection, a pilot test was conducted on 17 students to ensure clarity and face validity.\u003c/p\u003e\u003cp\u003eStudy size\u003c/p\u003e\u003cp\u003eA total of 288 students were planned to be included. The sample size was calculated via the following formula:\u003c/p\u003e\u003cp\u003en = (Zα/2)2 p(1-p)/d2\u003c/p\u003e\u003cp\u003ewhere n\u0026thinsp;=\u0026thinsp;sample size, Zα/2\u0026thinsp;=\u0026thinsp;Z value at (α\u0026thinsp;=\u0026thinsp;0.05)\u0026thinsp;=\u0026thinsp;1.96, p\u0026thinsp;=\u0026thinsp;prevalence\u0026thinsp;=\u0026thinsp;23% (estimated from the study conducted at the University of Gondar.) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)The proportion of nonoccurrence events to be studied was calculated as follows: 1-p\u0026thinsp;=\u0026thinsp;1-0.23\u0026thinsp;=\u0026thinsp;0.77 d\u0026thinsp;=\u0026thinsp;margin of error (precision)\u0026thinsp;=\u0026thinsp;0.05. A non-response rate of 5% was expected, resulting in a minimum sample size of 288.\u003c/p\u003e\u003cp\u003eBias\u003c/p\u003e\u003cp\u003eTo minimize selection bias, students were recruited from multiple academic years and across different universities. Moreover, designated investigators at each institution actively encouraged participation, aiming to reduce the risk of preferential response from individuals with heightened health awareness or preexisting IBS symptoms.\u003c/p\u003e\u003cp\u003eStatistical methods\u003c/p\u003e\u003cp\u003eAll analyses were performed via R version 4.4.1.\u003c/p\u003e\u003cp\u003eFrequencies and percentages were used to describe participant characteristics and IBS prevalence. The variables are summarized overall and by IBS status, as shown in the table below.\u003c/p\u003e\u003cp\u003eBinary logistic regression was used to examine the relationships between IBS status (dependent variable) and the independent variables. A regression model clustered by participants\u0026rsquo; universities was used to determine the predictors of IBS among the independent variables. Given the relatively small number of IBS cases reported in previous studies, including a large set of predictors in our model would have risked overfitting if case numbers were similarly low in this study. Therefore, drawing on prior evidence that consistently demonstrated strong associations between depression, anxiety, sex, and IBS among medical students in other countries (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), only these three variables were included as independent predictors in the regression model, although all variables were examined descriptively. Odds ratios (ORs), 95% confidence intervals (CIs), and p-values were calculated.\u003c/p\u003e\u003cp\u003eSensitivity analysis\u003c/p\u003e\u003cp\u003eBecause several universities contributed relatively small numbers of respondents, we conducted a sensitivity analysis excluding universities with fewer than five participants. The threshold of five was chosen to retain smaller medical schools (which often have fewer enrolled students) while avoiding undue influence from extremely small clusters; a higher cutoff would likely have excluded a disproportionate number of smaller universities. Model estimates were compared with the main analysis to assess robustness.\u003c/p\u003e\u003cp\u003eModel Performance and Evaluation\u003c/p\u003e\u003cp\u003eTo assess model performance, predicted probabilities from the final logistic model were used to generate a receiver operating characteristic (ROC) curve, as was done in other studies investigating predictors of a condition (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The area under the ROC curve (AUC) was calculated via the pROC package to quantify model discrimination. An AUC\u0026thinsp;\u0026gt;\u0026thinsp;0.7 was considered acceptable, as recommended in the literature (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHandling of Missing Data\u003c/p\u003e\u003cp\u003eThe final dataset contained no missing data on the included variables, as the submission of the questionnaires was completed once a participant finished all the questions and submitted them. Therefore, no imputation or exclusion procedures were needed.\u003c/p\u003e\u003cp\u003eEthical considerations\u003c/p\u003e\u003cp\u003e This study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from Addis Ababa University Internal Medicine Department Review Board, and informed consent was obtained from all participants prior to data collection.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 290 university students participated in the study (completed the questionnaire). Among these students, 20 (6.9%) met the criteria for irritable bowel syndrome (IBS), whereas 270 (93.1%) did not.\u003c/p\u003e\u003cp\u003eBaseline characteristics\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e outlines the baseline characteristics of the sample by IBS status. Among the participants without IBS, 104 (38.5%) were male, and 166 (61.5%) were female; among those with IBS, 4 (20.0%) were male, and 16 (80.0%) were female. The majority of participants were aged between 21\u0026ndash;30 years, comprising 207 (76.7%) in the non-IBS group and 17 (85.0%) in the IBS group. Overall, only 5 participants were aged over 30 years, none of whom had IBS. Students from all eight universities participated, but Addis Ababa University had a plurality, making up 41% of the non-IBS group and 45% of the IBS group. There were three universities with less than 5 participants in the study (Ambo University, Mizan Tepi University, and Wachamo University).\u003c/p\u003e\u003cp\u003eA family history of IBS was present in 19 (7.0%) non-IBS participants and 4 (20.0%) IBS participants. Anxiety was reported as \u0026ldquo;present\u0026rdquo; by 72 non-IBS (26.7%) and 13 IBS (65.0%) participants, whereas \u0026ldquo;borderline\u0026rdquo; anxiety was reported by 51 and 3 participants, respectively. For depression, 48 non-IBS (17.8%) and 4 IBS (20.0%) participants reported it as \u0026ldquo;present,\u0026rdquo; and 47 non-IBS (17.4%) and 8 IBS (40.0%) reported it as \u0026ldquo;borderline.\u0026rdquo;\u003c/p\u003e\u003cp\u003eAllergies were reported in 30 (11.1%) patients in the non-IBS group and in 6 (30.0%) patients in the IBS group. GPAs of 3.5\u0026ndash;4.0 were reported by 133 (49.3%) non-IBS participants and 8 (40.0%) IBS participants. Chronic illness was uncommonly reported by 28 non-IBS (10.4%) and 4 IBS (20.0%) participants. In terms of accommodation, most students lived in dormitories (161 non-IBS [59.6%], 9 IBS [45.0%]).\u003c/p\u003e\u003cp\u003eIn terms of lifestyle, 168 (62.2%) non-IBS and 15 (75.0%) IBS participants had never consumed alcohol, and 260 (96.3%) and 19 (95.0%) had never smoked cigarettes, respectively. Regular exercise was reported by only 27 non-IBSs (10.0%) and 1 participant with IBS (5.0%). The consumption of fast food was more common in the non-IBS group (57 [21.1%]) than in the IBS group (3 [15.0%]). Regarding sleep, 157 (58.1%) non-IBS participants and 9 (45.0%) IBS participants reported sleeping fewer than seven hours per night.\u003c/p\u003e\u003cp\u003eInferential analysis\u003c/p\u003e\u003cp\u003eA binary logistic regression model clustered by university status was used to examine the associations among depression, anxiety, sex, and IBS. Depression and anxiety categories were classified according to the Hospital Anxiety and Depression Scale (HADS) score as normal, borderline, or case (of anxiety or depression).\u003c/p\u003e\u003cp\u003eAnxiety was significantly associated with increased odds of IBS when participants classified as having anxiety were compared with those classified as normal (OR\u0026thinsp;=\u0026thinsp;7.25; 95% CI: 2.45\u0026ndash;21.43; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No statistically significant associations were detected for borderline anxiety (OR\u0026thinsp;=\u0026thinsp;1.80; 95% CI: 0.55\u0026ndash;5.95; p\u0026thinsp;=\u0026thinsp;0.332), borderline depression (OR\u0026thinsp;=\u0026thinsp;1.77; 95% CI: 0.47\u0026ndash;6.73; p\u0026thinsp;=\u0026thinsp;0.400), depression (OR\u0026thinsp;=\u0026thinsp;0.47; 95% CI: 0.16\u0026ndash;1.38; p\u0026thinsp;=\u0026thinsp;0.167), or female sex (OR\u0026thinsp;=\u0026thinsp;1.67; 95% CI: 0.70\u0026ndash;3.97; p\u0026thinsp;=\u0026thinsp;0.244).\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the full results of the logistic regression analysis. These findings suggest that, among the predictors examined, only anxiety showed a statistically significant association with IBS incidence in this sample.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eLogistic regression results for predictors of IBS, with standard errors clustered by university. Depression and anxiety categories were classified according to the Hospital Anxiety and Depression Scale (HADS) as normal, borderline, or case.CI refers to confidence interval.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAdjusted OR\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDepression\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBorderline depression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(0.47, 6.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDepression (case)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(0.16, 1.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnxiety\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBorderline Anxiety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(0.55, 5.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAnxiety (case)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(2.45, 21.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale (vs Male)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(0.70, 3.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e*Statistically significant p-values (\u0026lt;\u0026thinsp;0.05) are indicated with an asterisk (*).\u003c/p\u003e\u003cp\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003eReference categories were participants without depression and participants without anxiety for depression and anxiety, respectively.\u003c/p\u003e\u003cp\u003e\u003csup\u003e\u0026Dagger;\u003c/sup\u003eAdjusted for clustering by university.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSensitivity analysis\u003c/p\u003e\u003cp\u003eExcluding universities with \u0026lt;\u0026thinsp;5 respondents produced very similar estimates: anxiety remained strongly associated with IBS (OR 7.12, 95% CI 2.33\u0026ndash;21.72; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), while borderline depression (OR 1.84, 95% CI 0.56\u0026ndash;5.98; p\u0026thinsp;=\u0026thinsp;0.31); depression (OR 0.46, 95% CI 0.15\u0026ndash;1.38; p\u0026thinsp;=\u0026thinsp;0.17) and female sex (OR 1.61, 95% CI 0.68\u0026ndash;3.80; p\u0026thinsp;=\u0026thinsp;0.28) remained non‑significant.\u003c/p\u003e\u003cp\u003eThe central finding of a strong association between anxiety and IBS was robust in a sensitivity analysis that removed universities with fewer than five respondents, with effect sizes closely mirroring the primary model. This consistency suggests that including the three small university clusters did not significantly affect the results.\u003c/p\u003e\u003cp\u003eModel evaluation\u003c/p\u003e\u003cp\u003eThe area under the receiver operating characteristic (ROC) curve for the final logistic regression model was 0.776, indicating acceptable discriminative ability in identifying individuals with IBS. The predictors in this model were depression, anxiety, and sex, as described in the Statistical Methods section. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the ROC curve for this model, illustrating the trade-off between sensitivity and specificity across classification thresholds.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed the prevalence and associated factors of irritable bowel syndrome (IBS) among Ethiopian medical students, a group known to be at elevated risk for stress-related disorders. The impetus for this research was the limited evidence on IBS in sub-Saharan African medical student populations, despite their unique academic and psychosocial stressors.\u003c/p\u003e\u003cp\u003eOur findings indicate a prevalence of IBS of 6.89% among Ethiopian medical students, which is considerably lower than that reported in a previous study among Gondar University medical students (23%)(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). This difference may be attributed to several factors. First, the current study used the Rome IV criteria, which are more stringent and generally yield lower prevalence rates than previous criteria. Additionally, differences in participant demographics, environmental stressors, or academic workload may have contributed to the lower prevalence observed in our cohort.\u003c/p\u003e\u003cp\u003eConsistent with global evidence, we found a significant association between IBS and anxiety, underscoring the role of psychosocial factors in the pathophysiology of IBS among university students. This aligns with prior research, which identified emotional stress and anxiety as important risk factors for IBS(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). The lack of significant associations between IBS and borderline anxiety, depression, or borderline depression in our sample may be due to the relatively small number of students with IBS, limiting the statistical power to detect such relationships. Alternatively, cultural or contextual factors may modulate how stress and mental health symptoms are expressed and reported in this population.\u003c/p\u003e\u003cp\u003eUnlike findings from Western populations where IBS is more prevalent among females, our study did not demonstrate a significant difference between the sexes. This pattern is consistent with studies from Africa and parts of Asia, suggesting that the sex distribution of IBS may be influenced by genetic, environmental, or sociocultural factors specific to different regions (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). The associations between IBS and other known risk factors, such as dietary habits, socioeconomic status, and family history, were not statistically significant in this study, possibly reflecting the relatively homogenous lifestyle and dietary patterns among Ethiopian medical students or the insufficient sample size to detect these associations (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eStudies performed in most parts of the world, in low-, middle-, and high-income countries, report an increased rate of IBS in medical students compared with the rest of the population (\u003cspan additionalcitationids=\"CR29 CR30 CR31\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). While our prevalence was lower than that in many international reports, the observed association with anxiety is in line with the established literature. This finding highlights the need for ongoing mental health support and targeted interventions within medical training environments. On the African continent, studies on IBS in medical students reported a similarly high prevalence as that reported in the rest of the world (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study has many strengths. It is the first multicenter study on the prevalence and predictors of irritable bowel syndrome among Ethiopian medical students, to the best of our knowledge. This therefore fills a significant data gap in Ethiopia and Sub-Saharan Africa. Another notable strength of this study is the use of internationally accredited diagnostic criteria and psychological assessment tools, namely Rome IV and HADS, which further strengthen the reliability of the findings. Additionally, the diversity of participants in the year of medical education and university location makes the sample more representative.\u003c/p\u003e\u003cp\u003eDespite these strengths, some limitations should be acknowledged. The number of IBS cases was relatively modest; however, it was sufficient to detect meaningful relationships (particularly with anxiety). Although participation was voluntary, possibly introducing a modest risk of self-selection bias (including healthy volunteer bias), this was likely offset by the neutral distribution platform and efforts by investigators at each university to broadly encourage student participation.\u003c/p\u003e\u003cp\u003eIn conclusion, IBS is present among Ethiopian medical students, with anxiety emerging as a significant associated factor. The lower prevalence observed compared with that reported in previous local and international studies may reflect methodological and contextual differences. These findings underscore the importance of integrating psychosocial support into medical education to address both mental health and gastrointestinal symptoms among students. We believe that there is a strong need for multicenter and longitudinal research to clarify risk factors and develop effective preventive strategies in this population.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eGiven its prevalence and impact on quality of life, relatively few data on the epidemiology and risk factors for IBS at both the global and regional levels exist. Our findings highlight the potential influence of psychological factors on IBS among medical students in Ethiopia. However, the limited number of IBS patients in our sample may have reduced the statistical power to detect other associations. Further studies with larger and more diverse cohorts are recommended to better understand the psychosocial correlates of IBS in the medical student population.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAUC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eArea under the curve\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eConfidence interval\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHADS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHospital Anxiety and Depression Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHRQoL\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ehealth-related quality of life\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIBS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInflammatory bowel syndrome\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eOdds ratio\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eURL\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUniform Resource Locator\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e: No conflicts of interest are declared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e We would like to extend our appreciation to the International Institute for Primary Health Care, Ethiopia and Professor Getu Degu from Bahir Dar University for their constant guidance throughout the preparation of this manuscript. In addition, we would like to thank representatives at each participating university who encouraged students to participate in the research, especially Hawi Baye, Abigya Solomon Demeke, Tony Tsegaye, Kaleb Y. Tsega, Yordanos Dereje.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancing\u003c/strong\u003e: We have not received any funding for this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e: The data collected and analyzed in this study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e: We received ethical approval from the Addis Ababa University Internal Medicine Department Review Board.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e: Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003eThe final manuscript has been read by all the coauthors.\u003c/p\u003e\n\u003cp\u003eThe final manuscript has been approved for final submission by all the coauthors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Role\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eElias Tafesse Yeshitila:\u003c/strong\u003e Conceptualization, Project administration\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAll authors\u003c/strong\u003e: Data collection, review, compilation and synthesis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNanati Jemal Aliye:\u003c/strong\u003e Reviewed and edited the first draft\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbdulsemed Mohammed Nur\u003c/strong\u003e: Reviewed the first draft.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMengistu Yilma\u003c/strong\u003e: Reviewed the second draft.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eElias Taffesse Yeshitila:\u003c/strong\u003e Reviewed and edited the second draft\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAll authors\u003c/strong\u003e: Wrote the manuscript\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinal approval of manuscript\u003c/strong\u003e: All authors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003ewas designed by\u003cstrong\u003e\u0026nbsp;Elias Tafesse Yeshitila\u003csup\u003e1,2\u003c/sup\u003e,\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e was designed by \u003cstrong\u003e\u0026nbsp;Elias Tafesse Yeshitila\u003csup\u003e1,2\u003c/sup\u003e,\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 1.\u0026nbsp;\u003c/strong\u003ewas designed by \u003cstrong\u003e\u0026nbsp;Elias Tafesse Yeshitila\u003csup\u003e1,2\u003c/sup\u003e,\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eA D. 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Nutrients. 2022;14(14):2828.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Table 1","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"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":"Irritable Bowel Syndrome, Medical Students, Ethiopia, Anxiety, Rome IV, Cross-Sectional Study","lastPublishedDoi":"10.21203/rs.3.rs-7401772/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7401772/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eIrritable bowel syndrome (IBS) is a common disorder of gut\u0026ndash;brain interaction that significantly affects quality of life and is often linked to psychosocial factors. Although global and regional studies suggest higher IBS prevalence among medical students, evidence from Ethiopia remains scarce.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo determine the prevalence and predictors of IBS among Ethiopian medical students.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional study was conducted from June to August 2024 among undergraduate medical students from 11 Ethiopian universities. Data were collected via a self-administered online questionnaire incorporating the Rome IV criteria for IBS diagnosis, lifestyle and health variables, and the Hospital Anxiety and Depression Scale (HADS). Binary logistic regression clustered by university was used to assess associations between IBS and selected predictors (sex, anxiety, depression). Universities with less than five participants were excluded in a sensitivity analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOf 290 participants, 20 (6.89%) met the Rome IV criteria for IBS. Anxiety was significantly associated with IBS (OR\u0026thinsp;=\u0026thinsp;7.25; 95% CI: 2.45\u0026ndash;21.43; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while no significant associations were found with sex, depression, or borderline anxiety/depression. A sensitivity analysis excluding universities with less than five participants similarly showed significant association with anxiety. The final model showed acceptable discrimination (AUC\u0026thinsp;=\u0026thinsp;0.776).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eIBS prevalence among Ethiopian medical students was lower than previously reported locally and internationally, possibly due to the use of stricter diagnostic criteria and contextual factors. Anxiety emerged as a key associated factor, underscoring the need for psychosocial support within medical training programs. Larger, longitudinal studies are warranted to explore additional risk factors and inform targeted interventions.\u003c/p\u003e","manuscriptTitle":"Prevalence and Factors Associated with Irritable Bowel Syndrome among Medical Students in Ethiopia: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-30 06:49:18","doi":"10.21203/rs.3.rs-7401772/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-29T07:23:45+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-28T19:55:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"250985104023604695757099369073354544502","date":"2025-09-28T19:42:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-28T16:00:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"93614482985160636091174650758756021639","date":"2025-09-28T01:41:03+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-17T18:03:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-16T10:23:11+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-29T12:58:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-27T18:20:16+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2025-08-27T18:17:34+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":"fd1ab2ca-c63b-4bc0-9fbc-6cd97437674b","owner":[],"postedDate":"September 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T16:10:28+00:00","versionOfRecord":{"articleIdentity":"rs-7401772","link":"https://doi.org/10.1186/s12876-025-04415-8","journal":{"identity":"bmc-gastroenterology","isVorOnly":false,"title":"BMC Gastroenterology"},"publishedOn":"2025-11-26 15:57:58","publishedOnDateReadable":"November 26th, 2025"},"versionCreatedAt":"2025-09-30 06:49:18","video":"","vorDoi":"10.1186/s12876-025-04415-8","vorDoiUrl":"https://doi.org/10.1186/s12876-025-04415-8","workflowStages":[]},"version":"v1","identity":"rs-7401772","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7401772","identity":"rs-7401772","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}