The Prevalence and Risk Factors of Irritable Bowel Syndrome (PRIBS Study) Among Adults in Low- And Middle-Income Countries: An International Cross-Sectional Study

Background: Irritable bowel syndrome (IBS) is considered one of the most common chronic digestive disease that affects the quality of life of the people, and because of the plenty and abundance of risk factors, and the expected increase in the prevalence of IBS in the world in general and in the low and middle income countries in particular, our study was established aiming to assess and detect latent potential and apparent risk factors.Methods:This is international cross‑sectional study that was conducted in 15 low- and middle-income countries according to our previously protocol NCT05340400. Participants were recruited in the period from 22/April/ 2022 to 14/June/2022. The diagnosis of the IBS was according to ROME IV. We determined the physical activity, daily stress, and fatigue of the participants. A large number of collaborators were chosen from different regions and institutions within each country to achieve diversity within the sample and reduce the probability of bias.Findings: The prevalence of IBS appears to be more in low- and middle-income countries (mean = 25.2%, range [6.2% – 44.2%]) than in high-income countries, and with a higher prevalence among Africans than Caucasians and Asians. The prevalence of the IBS increased at fourth decade 32.1% and fifth decade 31.1% p. value = .000. In addition to the previously known risk factors for IBS such as female sex, smoking, psychological stress, and chronic fatigue, other risk factors are chronic diseases, including high blood pressure and diabetes, allergic to some substances, previous infection with COVID 19, and the participant who has a patient first degree relative. Also some other modifiable risk factors such as abnormal BMI (whether high or low), smoking, a protein- or fat-rich diet, drinking caffeine beverages, and poor physical activity.Interpretation: The pathophysiology of IBS is functional impairment of the GI tract with the absence of any obvious biological abnormalities. This functional impairment is centered around three main principles: altered GI motility, GI hyperalgesia, and psychopathology. The latter may justify the increased prevalence in stressed individuals as well as people who sleep less than six hours.Funding Information: There is no source for funding.Declaration of Interests: All authors declare no competing interests.Ethics Approval Statement: This research was conducted under ethical approval from the Faculty of Medicine, University of Aleppo, Aleppo, Syria. And each national lead has sent ethical approval from an institution in his/her country.