In this study, we included 100 patients among the patients consulting the hepato-gastroenterology department of Charles Nicolle Hospital over a 12-month period from February 2019 to January 2020.
Our population was mainly female with a M/F sex ratio of 0.53.
The mean age of our patients was 50.53 years with extremes ranging from 16 to 91 years and a median of 54 years. The majority of patients were between 35 and 65 years of age. The mean age for women was lower than for men (48.67 versus 53.45 years).
The majority of our patients were from the north of the country, with an average level of education, and half of them were unemployed. For the other half, the majority worked in the liberal sector.
The socio-economic level of our patients was assessed by comparing their monthly income to the guaranteed minimum wage (SMIG) (about 400dt). Half of our patients had an income between 400 and 1000dt, which correspond to an average socio-economic level.
Most of our patients were married (66%), the others were single (25%), widowed (8%) or divorced (1%). On the other hand (25%) of our patients had no children, the rest of our patients had an average of 2.2 children.
Regarding the clinical data of the patients, the average body mass index (BMI) of our patients was 27.53 [19.03–44.12], 35% of the patients were of normal weight, 40% were overweight and the remaining 25% of the subjects were considered obese.
More than half of our patients had one or more comorbidities. These were dominated by diabetes and hypertension and 16% had a history of surgery, mainly visceral and gynecological.
With regard to manifested symptomatology, pain was a consistent symptom in the clinical criteria for irritable bowel syndrome. Constipation was the predominant transit disorder found in 65% of patients. Alternating diarrhea and constipation were noted in 11 patients.
In accordance with the above results and the Rome IV criteria, we were able to define the subtypes of IBS that our patients presented. IBS with a predominance of constipation was the predominant subtype (54%). Twenty-eight percent of the patients had diverse symptomatology and were therefore classified as non-specific IBS.
Eighteen percent of the patients used self-medication mainly with antispasmodics and transit regulators, 36% (N = 36) took a phyto/homeopathic treatment mainly vervain, fennel seed and curcumin infusions.
All patients included in our study had a colonoscopy. This examination was well tolerated in 60% of cases. A dolichocolon was found in 34% of patients.
Fifty-eight percent of the patients underwent abdominal ultrasound, which revealed hepatic steatosis in 21% of cases.
The overall SF-36 score of our patients had a median of 41.6%, a mean of 41.2%, extremes ranging from 22.3–56% and an IQ 25–75 equal to [35.8 ;46.9].
The score of the eight items of the MOS SF-36 was calculated for all patients, referring to their answers to the questionnaires:
The GH (General Health) score ranged from 5 to 67 with a median of 50%, a mean of 46.7% and an IQ 25–75 equal to [40;52].
The PF (Physical Functioning) score ranged from 0 to 100 with a median of 80%, a mean of 74% and an IQ 25–75 of [56,36;95].
The RP (Role Physical) score ranged from 0 to 100 with a median and mean of 50% and a 25–75 IQ of [0,100].
The Body Pain (BP) score, reflecting the patient's physical pain, ranged from 0 to 100 with a median of 52%, a mean of 50.9% and an IQ 25–75 of [32,72].
The PCS score summarizing these 4 scores and reflecting the patient's physical quality of life had a median of 42.9%, a mean of 42.5%, extremes ranging from 22.8–57.3% and with an IQ 25–75 equal to [35.9;49].
Figure 1 summarizes the figures for the physical quality of life scores.
The second part of the questionnaire providing information on the psychological/mental quality of life was analysed through the 4 other scores:
The "RE" (Role Emotional) score, which indicates the psychological impact on the patient's activity, ranged from 0 to 100, with a median of 66.6%, a mean of 51.25% and an IQ 25–75 equal to [0,100].
The "SF" or social functioning score, relating to the negative impact of the disease on the patient's social life, ranged from 25 to 100 with a median of 75%, a mean of 67% and an IQ 25–75 equal to [50;96.87].
The "VT" (Vitality) score informing on tiredness and the impact of the disease on energy varied from 0 to 90 with a median of 45%, a mean of 45% and an IQ 25–75 equal to [31,25 ; 60].
Finally, the Mental Health (MH) score, which provides information on the patient's mental health in general, had values between 4 and 100 with a median of 52%, a mean of 53.45% and an IQ of 25–75 equal to [41,74].
The MCS score summarizing these 4 scores and reflecting the patient's mental quality of life had a median of 40.8%, a mean of 39.9%, extremes ranging from 9.8 to 65% and an IQ 25–75 equal to [31.5 ;49.8].
Figure 2 summarizes the figures for the psychological quality of life scores.
We looked for factors that significantly influence the different items of the MOS SF-36.
To do this, we evaluated the correlation between the epidemiological and clinical parameters with these different items relating to the physical and mental health of our patients.
We found that the physical health parameters (PCS and PF) were inversely related to age.
Regarding gender, all the mean scores calculated for our patients were higher for men than for women, and the difference was statistically significant for all these scores except for the physical health scores PF, RP and GH.
Low educational level was associated with impaired physical, mental and global quality of life.
There was a significant association between low socio-economic level and all the scores evaluated except for the FS.
Regarding the marital status of the patients, the means of the different scores were higher in single patients than in other patients but there was a statistically significant association only with the MCS score providing information on the globality of the mental quality of life items.
Clinically, all scores had lower means in diabetic patients than in non-diabetic ones. A statistically significant association was found between diabetes and the psychological quality of life items VT, SF and MCS.
On the other hand, almost all the mean scores were better in non-hypertensive patients compared to hypertensive ones, but the difference was only statistically significant for the physical (PCS, PF and BP), mental (VT) and global (SF36) quality of life scores.
Similarly, non-hypothyroid patients had better quality of life scores than the others except for the GH score, but this difference was only statistically significant for the SF36 global score, the PCS physical quality of life score, its RP and BP items and the mental quality of life score (RE).
There was no significant association between the different items of the MOS SF-36 and the presence of previous surgery.
Focusing on the different IBS subtypes, we found that there was no statistically significant difference for all questionnaire scores for the diarrhoea-predominant subtype.
We were able to show a statistically significant association between some quality of life scores with the subtype where constipation was predominant. Indeed, the mental quality of life scores (MCS, SF, MH and VT) were significantly lower with p = 0.39; 0.017; 0.036 and 0.010 respectively as well as the SF-36 global score with p = 0.49
For the mixed subtype, there was no statistically significant relationship between this subtype and the different scores assessed in our study.
Similarly, no statistically significant relationship was found for the mixed subtype with the MOS SF-36 scores.
For patients who used homeopathy and herbal medicine to relieve their symptoms, only the GH score was significantly different between patients who used homeopathy/herbal medicine and those who did not (p = 0.31).
On the other hand, the existence of a dolichocolon at colonoscopy had a significant association only with the mental quality of life (MOE) item (p = 0.19) and all scores were lower in patients with this anatomical feature.
It should be noted that the MOS SF-36 scores were lower the more important the BMI was. There was a significant association between the different BMI classes and some items of the physical (GH, PF, PCS) and mental (VT and MCS) quality of life scores as well as with the SF36.
The following table (Table 1) summarizes the results of the parameters influencing the physical, mental and global quality of life scores.
Table 1
Summary table of significant associations with MOS SF-36 items
| Physical quality of life | Mental quality of life | Global quality of life |
PCS | PF | RP | BP | GH | MCS | VT | RE | MH | SF | SF-36 |
Age | 0,02 | <\({10}^{-3}\) | | | | | | | | | |
Gender | 0,025 | | | 0,002 | | 0,002 | 0,005 | 0,008 | 0,013 | 0,036 | 0,003 |
Level of studies | 0,003 | 0,017 | | 0,005 | 0,007 | | <\({10}^{-3}\) | | | | 0,011 |
Sectot of work | | | | 0,01 | | 0,009 | 0,047 | | <\({10}^{-3}\) | | 0,005 |
Socio economic level | 0,016 | 0,04 | 0,013 | 0,003 | 0,01 | 0,004 | 0,005 | 0,007 | 0,01 | | 0,001 |
Civil status | | | | | | 0,028 | | | | | |
Dibetes | | | | | | 0,04 | 0,008 | | | 0,021 | |
Hypertension blood pressure | 0,023 | 0,014 | | 0,042 | | | 0,032 | | | | 0,041 |
Hypothyroidism | 0,037 | | <\({10}^{-3}\) | 0,01 | | | | 0,018 | | | 0,034 |
Body mass index | 0,003 | <\({10}^{-3}\) | | 0,024 | | 0,012 | 0,045 | | | | 0,033 |