Prevalence Of Irritable Bowel Syndrome, Its Risk Factors, And Impact On Increasing Anxiety And Depression Among Egyptian Medical Students
Conditions: Irritable Bowel Syndrome
Sponsor: Zagazig University

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Official Name: Prevalence Of Irritable Bowel Syndrome, Its Risk Factors, 
And Impact On Increasing Anxiety And Depression Among Egyptian 
Medical Students Protocol 
Authors 
Ahmed I Elagrody 
professor of internal medicine, Zagazig University, Zagazig, Egypt.  
Abdelmonam M Hagag 
Faculty of Medicine, Zagazig University, Zagazig, Egypt. 
Gannah S El Labban 
Faculty of Medicine, Ain Shams University, Cairo, Egypt. 
Nourhan Mohamed Shaaban 
Radiology Resident, Faculty of Medicine, Alexandria University, Alexandria, 
Egypt. 
Karim M Abdelmoaty 
Faculty of Medicine, Zagazig University, Zagazig, Egypt.  
Mohamed Mahmoud khalaf 
Faculty of Medicine, Benha University, Benha, Egypt. 
Bayan Eid Nasr 
Faculty of Medicine, Port said University, Post said, Egypt. 
Omar R Ayad 
Faculty of Medicine, Zagazig University, Zagazig, Egypt 
NCT Number: NCT07033936 
Study Date: June 3, 2025 

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Introduction 
One of the most common gastrointestinal disorders is irritable bowel syndrome 
(IBS). It is a chronic functional bowel disease in which abnormal bowel habits, such as 
diarrhea, constipation, or both, are associated with abdominal pain and 
distension(Longstreth et al., 2006; Mearin et al., 2016). Around 11% of the general 
population suffers from their symptoms regardless of the geographical distribution(Card 
et al., 2014). 
Irritable bowel syndrome is more common among females and patients younger 
than 50(Lovell & Ford, 2012). For medical students, IBS is common and may affect up to 
25% of them.(El Sharawy et al., 2022; Zedan et al., 2024).  Especially final–year 
students, due to the increasing workload of the final year.(Alaqeel et al., 2017) 
        Several risk factors increase the prevalence of irritable bowel syndrome , including 
environmental factors, life events, and junk food abuse(Surdea-Blaga, 2012). Also, 
psychological disorders as severe levels of anxiety, depression, and stress, may contribute 
to the occurrence of irritable bowel syndrome, and this can be explained by the 
pathophysiology of IBS, maybe by brain-gut interaction(Rafiq Khan Final Year MBBS et 
al., 2018; Surdea-Blaga, 2012). 
        Globally, the prevalence of anxiety and depression is higher in medical students 
compared to other populations(Banstola & Lamichhane, 2024), as it reaches up to 
38.7% among them.(Tian-Ci Quek et al., 2019). Many factors play a role in increasing 
the prevalence of anxiety and depression among medical students as stressful courses in 
medical study, exposure to the death of patients, and others(Guthrie et al., 1995; Williams 
et al., 2005). 
Rational 
         In Egypt, the prevalence of medical students suffering from stress and anxiety is 
high due to several problems as financial problems, work overload, traditional methods of 
education, and the increasing number of students, making communication with the 

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lecturer difficult(El-Gilany et al., 2008)  and that increase incidence of IBS among 
Egyptian medical students.  
        Just as anxiety is considered a risk factor for the development of Irritable Bowel 
Syndrome (IBS), IBS can also lead to the occurrence of anxiety and depression, and that 
can be explained by brain–gut interaction(Abdelaziz et al., 2023; Zamani et al., 2019). 
Patients with IBS have a three-times increased risk of either anxiety or depression, 
compared to healthy subjects.(Zamani et al., 2019) 
Although the importance of this topic is recognized, there are limited data about 
the exact prevalence of irritable bowel syndrome among medical students in Egypt. 
Previous studies(El Sharawy et al., 2022; Elhosseiny et al., 2019; Zedan et al., 2024) have 
discussed this topic in three medical schools in Egypt, but their sample size were too 
small, and they did not assess the associated anxiety and depression among these 
students, so we cannot rely on these studies. This is the first study in Zagazig University 
hospital to assess the prevalence of irritable bowel syndrome among both medical 
students and medical interns, and the most significant risk factors of this condition and 
highlight the association between IBS symptoms and anxiety and depression. 
Research Question 
1. What is the prevalence of irritable bowel syndrome among Egyptian medical 
students and medical interns? 
2. What are the risk factors that increase its prevalence? 
3. Can irritable bowel syndrome increase anxiety and depression among these 
students? 
Aim: 
 to increase awareness about the prevalence of irritable bowel syndrome among Egyptian 
medical students, and its risk factors, to improve these students' quality of life. 
Objectives 

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• To assess the prevalence of irritable bowel syndrome among Egyptian Medical 
students and medical interns 
• To evaluate the most common risk factors that increase its prevalence 
• To assess its effect on increase students’ anxiety and depression. 
Methodology 
A. Technical design 
• Study Design: Cross-sectional study 
• Setting: Medical students who have access to online platforms 
• Time: 2025-2026 
• Population: Egyptian Medical students and medical interns. 
• Inclusion criteria 
➢ Egyptian Medical students and interns 
➢ Their age ranges from 18 to 29 years 
➢ Have access to online platforms such as Facebook, WhatsApp, and 
Telegram. 
➢ Accept to participate in the  questionnaire 
• Exclusion criteria 
➢ Participate who refused to participate  
• Sampling 
We calculated the total sample size based on the total medical students in 
Egypt, according to the Central Agency for Public Mobilization and 
Statistics(Capmas, n.d.) 2023-2024, which is 115688 students. The 
calculation was done using Epi Info version 7.2.60 (<i>Epi InfoTM | CDC</i>, 
n.d.)Assuming that the prevalence is 50%, and taking a 5% error margin and 
95% confidence interval, the sample size is 383. After adding a 10% non-
response rate, the final sample size is about 422 
  

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• Sample technique: The convenient sampling will be applied in this study 
B. Operational design 
• Pilot study: We will perform a pilot study to assess the readability of the 
questionnaire. We will perform it on 10% of the expected population, and 
any changes will be made accordingly. The pilot study results will be 
excluded from the main analysis  
• Study field: an online questionnaire will be shared through social media 
platforms such as WhatsApp, Facebook, or Telegram. 
• Data collection method: 
An online questionnaire in English designed by Google Forms will be 
shared through online platforms such as WhatsApp, Telegram, and X. The 
questionnaire asks about the following: 
➢ Sociodemographic data such as age, sex, residency, academic year, 
and BMI 
➢ Risk factors of IBS such as stress level, type of personality, smoking, 
monthly income, and junk foods  
➢ Diagnosis of irritable bowel syndrome based on Rome IV 
criteria(Mearin et al., 2016). To diagnose IBS, the students should 
have at least two of the three criteria in the Rome IV. The presence 
of two or more of the symptoms diagnoses the disease 
➢ Anxiety and depression levels. This section is based on the HAD 
criteria for diagnosing anxiety and depression(Zigmond & Snaith, 
1983).  
This is a 14-item questionnaire, 7 items to assess anxiety and the other 7 to diagnose 
depression. Each question has 4 answers coded from 0 to 3, so for each part, the patients 
can have a score from 0 to 21.  A patient is classified to have a normal, borderline, or 
abnormal level of anxiety or depression if he has a cumulative score of (0-7), (8-10), or 
(11-21), respectively. 

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• Statistical analysis:  
➢ The data will first be summarized to have an idea about the baseline 
characteristics of the participants. Categorical data will be 
summarized into numbers and percentages, while continuous data 
will be summarized into mean and SD or median and IQR after 
testing their normality.  
➢ The Mann-Whitney U test will be used to assess the difference 
among the different baseline data such asses the sex, residency and 
living situation 
➢ Finally, a binary logistic regression will be conducted to assess the 
correlation between increasing IBS symptoms and increasing anxiety 
and depression rates. 
➢ All the analyses will be held using SPSS version 29, and Microsoft 
Excel will be used to prepare the data and outcomes in suitable 
tables and figures. 
C. Administrative design 
• Ethical considerations 
➢ The study protocol will be approved by the Institutional Review 
Board of Zagazig University, Faculty of Medicine 
➢ Study participants will be included after informed consent. 
• Confidentiality and data retention 
Data collected will be kept confidential. 
• Risks and benefits of the participants 
There is no cost for this study 
Results 
Collected data will be presented in tables and suitable graphs, and analyzed according to 

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standard statistical methods. 
Discussion 
Discussion will be done on the results compared to the relevant literature and scientific 
Research 
References 
Abdelaziz, H. A., Ellakany, W. I., Ellakany, A., Dean, Y. E., Rouzan, S. S., Bamousa, B. A. A., 
Shebl, M. A., Elawady, S. S., Verma, S., Gir, D., Sbitli, T., Zaki, I., Motwani, L., Eweis, R., 
Iqbal, N., Shah, J., & Aiash, H. (2023). The relationship between anxiety and irritable 
bowel syndrome symptoms among females: A cross-sectional study in Egypt. 
Medicine, 102(32), e34777. https://doi.org/10.1097/MD.0000000000034777 
Alaqeel, M. K., Alowaimer, N. A., Alonezan, A. F., Almegbel, N. Y., & Alaujan, F. Y. (2017). 
Prevalence of Irritable Bowel Syndrome and its Association withAnxiety among 
Medical Students at King Saud bin Abdulaziz University for Health Sciences in Riyadh. 
Pakistan Journal of Medical Sciences, 33(1). https://doi.org/10.12669/pjms.331.12572 
Banstola, S., & Lamichhane, S. (2024). Prevalence of anxiety among pre-clinical medical 
students: A cross-sectional study. Journal of Gandaki Medical College-Nepal, 17(1), 
68–72. https://doi.org/10.3126/jgmcn.v17i1.65583 
Capmas. (n.d.). Retrieved January 31, 2025, from 
https://www.capmas.gov.eg/HomePage.aspx 
Card, T., Canavan, C., & West, J. (2014). The epidemiology of irritable bowel syndrome. 
Clinical Epidemiology, 71. https://doi.org/10.2147/CLEP.S40245 
El Sharawy, S. M., Amer, I. F., & Elkadeem, M. Z. (2022). Irritable bowel syndrome in 
Egyptian medical students, prevalence and associated factors: a cross-sectional 
study. Pan African Medical Journal, 41. 
https://doi.org/10.11604/pamj.2022.41.311.28228 
El-Gilany, A.-H., Amr, M., & Hammad, S. (2008). Perceived stress among male medical 
students in Egypt and Saudi Arabia: effect of sociodemographic factors. Annals of 
Saudi Medicine, 28(6), 442–448. https://doi.org/10.5144/0256-4947.2008.442 
Elhosseiny, D., Mahmoud, N. E., & Manzour, A. F. (2019). Factors associated with irritable 
bowel syndrome among medical students in Ain Shams University. Journal of the 

Page 8 of 9 
 
Egyptian Public Health Association, 94(1), 1–9. https://doi.org/10.1186/S42506-019-
0023-8/TABLES/7 
Epi InfoTM | CDC. (n.d.). Retrieved January 13, 2025, from 
https://www.cdc.gov/epiinfo/index.html 
Guthrie, E. A., Black, D., Shaw, C. M., Hamilton, J., Creed, F. H., & Tomenson, B. (1995). 
Embarking upon a medical career: psychological morbidity in first year medical 
students. Medical Education, 29(5), 337–341. https://doi.org/10.1111/j.1365-
2923.1995.tb00022.x 
Longstreth, G. F., Thompson, W. G., Chey, W. D., Houghton, L. A., Mearin, F., & Spiller, R. C. 
(2006). Functional bowel disorders. Gastroenterology, 130(5), 1480–1491. 
https://doi.org/10.1053/j.gastro.2005.11.061 
Lovell, R. M., & Ford, A. C. (2012). Global Prevalence of and Risk Factors for Irritable Bowel 
Syndrome: A Meta-analysis. Clinical Gastroenterology and Hepatology, 10(7), 712-
721.e4. https://doi.org/10.1016/j.cgh.2012.02.029 
Mearin, F., Lacy, B. E., Chang, L., Chey, W. D., Lembo, A. J., Simren, M., & Spiller, R. (2016). 
Bowel Disorders. Gastroenterology, 150(6), 1393-1407.e5. 
https://doi.org/10.1053/j.gastro.2016.02.031 
Rafiq Khan Final Year MBBS, A., Rafiq Khan, A., Khan, A., Ahmad, F., & Abbas, Y. (2018). 
PREVALENCE OF IRRITABLE BOWEL SYNDROME AND ITS ASSOCIATION WITH STRESS 
AND OTHER RISK FACTORS AMONG UNIVERSITY STUDENTS OF PESHAWAR. Journal 
of Medical Sciences, 26(4), 312–316. 
https://jmedsci.com/index.php/Jmedsci/article/view/597 
Surdea-Blaga, T. (2012). Psychosocial determinants of irritable bowel syndrome. World 
Journal of Gastroenterology, 18(7), 616. https://doi.org/10.3748/wjg.v18.i7.616 
Tian-Ci Quek, T., Wai-San Tam, W., X. Tran, B., Zhang, M., Zhang, Z., Su-Hui Ho, C., & Chun-
Man Ho, R. (2019). The Global Prevalence of Anxiety Among Medical Students: A Meta-
Analysis. International Journal of Environmental Research and Public Health, 16(15), 
2735. https://doi.org/10.3390/ijerph16152735 
Williams, C. M., Wilson, C. C., & Olsen, C. H. (2005). Dying, Death, and Medical Education: 
Student Voices. Journal of Palliative Medicine, 8(2), 372–381. 
https://doi.org/10.1089/jpm.2005.8.372 
Zamani, M., Alizadeh‐Tabari, S., & Zamani, V. (2019). Systematic review with meta‐analysis: 
the prevalence of anxiety and depression in patients with irritable bowel syndrome. 

Page 9 of 9 
 
Alimentary Pharmacology & Therapeutics, 50(2), 132–143. 
https://doi.org/10.1111/apt.15325 
Zedan, A. M. E., Mohamed Abdu, E. Z., & Abdelrazik, R. K. (2024). Prevalence of irritable 
bowel syndrome among Egyptian undergraduate physiotherapy students of Benha 
University. Benha International Journal of Physical Therapy, 0(0), 1–5. 
https://doi.org/10.21608/bijpt.2024.291359.1025 
Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta 
Psychiatrica Scandinavica, 67(6), 361–370. https://doi.org/10.1111/j.1600-
0447.1983.tb09716.x