Prevalence of Irritable Bowel Syndrome, Functional Dyspepsia and their Overlap in Bulgaria: a Population-Based Study

Abstract

Aims: We aimed to evaluate the prevalence of irritable bowel syndrome (IBS), functional dyspepsia (FD), and their overlap syndrome (OS) in the Bulgarian population and to assess the risk factors associated with these disorders.
 Methods: We sent an internet-based survey to Bulgarian adults. The survey collected data on socio- demographic, behavioral and lifestyle characteristics, and diagnostic questions following the Rome IV criteria to assess IBS, FD and their overlap occurrence.
 Results: Data was collected from 1,896 individuals (mean age = 35.5 years, 18-65, SD=11.7), 73.1% females. The prevalence of IBS was 20% (14% were with predominant constipation, 32% with predominant diarrhea, 52% had IBS with mixed bowel habits, and 2% unclassified IBS). Gender (p=0.005), age (p<0.001), marital status (p=0.009), occupation (p=0.001), alcohol consumption (p=0.013), sexual problems (p<0.001), FD (p<0.001), and milk intolerance (p<0.001) were significantly associated with IBS. Females (p=0.032; OR: 1.50), patients with FD (p<0.001; OR: 104.98), sexual problems (p= 0.001; ОR: 1.55 ), and milk intolerance (p<0.001; OR: 2.22) are at a higher risk of having IBS. The prevalence of FD was 12.7% (39% had postprandial distress syndrome, 33% epigastric pain syndrome, and 28% had the overlapping variant). Patients with IBS (p<0.001; OR: 127.88) and milk intolerance (p<0.001) were significantly associated with FD prevalence. The prevalence of OS was 11.7%. Gender (p=0.013), milk intolerance (p<0.001, OR: 1.65), urinary (p=0.035) and sexual problems (p<0.001, ОR: 1.80) were associated with OS prevalence.
 Conclusion: This is the first study to estimate the prevalence of IBS, FD, and their OS and assess the behavioral and demographic risk factors associated with these disorders in the Bulgarian population. Our results are valuable in filling in the epidemiological data gap regarding IBS, FD, and OS in Eastern Europe.

Gastrointestinal Symptoms and Irritable Bowel Syndrome Are Associated With Female Sex and Smoking in the General Population and With Unemployment in Men

“…However, when performing logistic regression and adjusting for confounders, no association between IBS or GI symptoms and BMI groups could be found. These differences in calculations may explain contradictory results from other studies regarding BMI and IBS (9)(10)(11). Neither marital status nor education did have any effect on IBS or GI symptoms, although this has been described in previous studies (8,9).…”

“…These differences in calculations may explain contradictory results from other studies regarding BMI and IBS (9)(10)(11). Neither marital status nor education did have any effect on IBS or GI symptoms, although this has been described in previous studies (8,9).…”

“…Other studies have shown that 12-17% of those with IBS report alcohol intolerance, and 50% restrain themselves from drinking (38)(39)(40). This can explain why the IBS prevalence was higher in non-users of alcohol (9). On the other hand, there is a strong association between poor psychological wellbeing and severe GI symptoms (1,2), and people with more pain could also have a reason for more drinking, as alcohol is associated with calming and numbing effects (22).…”

“…Female patients with IBS in Iran were more often single and being unemployed than patients without IBS (8), whereas married or single subjects in a Bulgarian population-based study had lower IBS prevalence than those only living in a relationship (9). An inverse association between IBS and body mass index (BMI) was observed in men in one large French study (10), with no association between IBS and BMI when calculations were performed with both sexes together (9)(10)(11).…”

“…The role of alcohol has been even more difficult to determine, showing no association (14,15), a tendency toward less symptoms with a moderate alcohol intake (13), or aggravated symptoms after high intake of alcohol (12,15). On the other hand, a higher prevalence of IBS was found in non-users of alcohol in a population-based Bulgarian study (9). The role of snuff, a Swedish variant of tobacco, has not been examined regarding its association with FGIDs.…”