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. 2024 Jul 26;16(7):e65421. doi: 10.7759/cureus.65421

Prevalence of Irritable Bowel Syndrome (IBS) in the Arab World: A Systematic Review

Omar Almansour 1,✉
Editors: Alexander Muacevic, John R Adler
PMCID: PMC11344969  PMID: 39184662

Abstract

Irritable Bowel Syndrome (IBS) is a common functional pathology of the gastrointestinal tract (GIT) across the globe. The prevalence rate of IBS varies across the regions. In the present systematic review, we aim to investigate the prevalence of IBS in Arab countries in recent years. To identify relevant studies, a comprehensive search was undertaken in various databases including CINAHL (Cumulated Index to Nursing and Allied Health Literature) Ultimate, Scopus, PubMed, and Web of Science. Furthermore, Google Scholar was also explored to identify relevant studies. The inclusion criteria included studies that assessed IBS in the Arab world and were published in the English language. Fifty-two cross-sectional studies from seven countries, encompassing 51,683 participants, were included. The majority of the included studies were conducted in Saudi Arabia (n=40), followed by Jordan (n=4) and Egypt (n=3). The highest prevalence rates were reported by studies from Saudi Arabia, Lebanon, and Jordan. Low prevalence rates (<20%) were noted in 19 studies included in this systematic review. Female predominance in IBS prevalence was observed in most studies, while only two studies indicated higher prevalence in males. Key risk factors included family history, anxiety, depression, gastroesophageal reflux disease, low income, diabetes, low water intake, workload, occupation, food allergy, smoking, age, chronic diseases, and stress. IBS prevalence in the Arab world varies significantly. Female predominance was seen in the present systematic review as well.

Keywords: middle east, arab world, prevalence, ibs, irritable bowel syndrome

Introduction and background

Irritable bowel syndrome (IBS) is a chronic functional pathology of the gastrointestinal tract (GIT). This disease is characterized by chronic abdominal pain, bloating, and altered bowel habits, which can significantly impair the quality of life [1]. The severity of symptoms varies in different individuals with some experiencing severe disease whereas others experiencing mild symptoms. The pathophysiology of IBS is not completely understood; however, it is believed to be a multifactorial pathology [2,3]. Due to variations in symptoms, the diagnosis of IBS poses challenges. Furthermore, there is a lack of precise biomarkers and sensitivity and specificity testing. Different diagnostic guidelines have been proposed such as Kruis scoring system and Manning and Rome criteria. The Rome I, II, and III criteria have been widely adopted for the diagnosis of IBS. Recently, Rome IV criteria is the most commonly accepted criteria for IBS [4] .

IBS is a multifactorial condition with several risk factors. Previously, studies have recognized both mental and physical factors to influence the development of IBS. For example, stress has been implicated in the progression of the disease [5]. Other well-known risk factors of IBS include chronic inflammation of the intestine, and altered intestinal flora [6,7]. Due to the involvement of various risk factors, the prevalence of IBS is influenced by genetic, environmental, cultural, and dietary factors. Throughout the world, the prevalence of IBS varies considerably. Approximately 10-20% of the population in the world suffers from IBS. Women and individuals aged below the age of 50 years are particularly vulnerable to IBS [8]. Epidemiological studies on IBS in the Arab world are relatively scarce compared to Western countries. However, the available literature suggests that the prevalence of IBS in the Arab world is comparable to, if not higher than, that in Western countries. A systematic review by Almasary et al. reported a pooled prevalence of 20.7% in Saudi Arabia [9]. Their systematic review and meta-analysis included 38 studies and 26,567 participants.

The difference in prevalence in the Arab nations can be due to various factors including lifestyle, diet, and healthcare access. Traditional healthcare practices and varying levels of awareness and education about IBS among healthcare providers and the general population further complicate the epidemiological landscape of IBS in the Arab world. For example, a study by Issa et al. reported that only 50% of the participants were aware of IBS in Saudi Arabia [10]. Healthcare infrastructure and access to medical care vary widely across the Arab world, affecting the diagnosis and management of IBS. In some countries, advanced healthcare facilities and specialized gastrointestinal clinics are available, while others may have limited resources. There has been a continuous rise in the prevalence of IBS in the Arab World. For example, Isbister and Hubler reported in 1998 that the prevalence of IBS is rare in Saudi Arabia [11]. Similarly, a prevalence of 1.35/100 000 person-years was reported from Oman in 1997 [12]. However, a systematic review by Alosaimi et al. reported a prevalence of 8.9-31.8% in the Arab world in 2016 [13].

As IBS can have a significant impact on the quality of life and healthcare systems, it is important to understand the exact prevalence of IBS in the Arab world as currently, there is a paucity of up-to-date research on this. This systematic review aimed to summarize the latest evidence on IBS in the Arab World.

Review

Search strategy

A systemic search was carried out in various databases to identify the prevalence of IBS in the Arab World. The searched databases included PubMed, Web of Science, CINAHL (Cumulated Index to Nursing and Allied Health Literature) Ultimate, and Scopus. To further increase the relevant literature, Google Scholar was also searched. A combination of keywords was used during the search strategy. Commonly used keywords included Epidemiology,” or “Incidence,” “Irritable bowel syndrome,” or “IBS,” and “Arab World,” or “Middle East”. Apart from these keywords, different alternatives of the keywords were also used. The details of all the keywords are presented in the Appendix A. The inclusion criteria of this systemic review were as follows: (i) studies that investigated the prevalence of IBS in the Arab world; (ii) studies that were published in English, and (iii) studies that were published between 2019 and 2024. The exclusion criteria for the systematic review included studies that identified the prevalence of IBS but were conducted outside the Arab world.

Data collection process

Database search results were transferred to a reference manager (EndNote 20, Clarivate Plc, Philadelphia, Pennsylvania, United States). At this stage, the duplicates were removed. For screening the potential studies, the EndNote file was transferred to Rayyan, a research collaboration platform [14]. Two independent reviewers were involved in the further process. In the Ryyan software, the blind was turned on to ensure that there was no bias in the selection process. Next, the selection of studies was based on the title and abstract of the studies. Finalized studies were cross-checked by both reviewers and uncommon studies were either excluded or included by discussion among reviewers. In case of any differences in opinion, a third reviewer was involved in the process to finalize the status of inclusion. After that, the detailed data from the searched studies were transferred to Excel (Microsoft Corporation, Redmond, Washington, United States), and notes about the intervention used, participants, and results were obtained.

Results

Figure 1 shows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of the systematic review.

Figure 1. PRISMA flow diagram of the systematic review.

Figure 1

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PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Included Studies

The literature search yielded 506 studies from PubMed (n=182), CINAHL Ultimate (n=33), Scopus (n=134), Web of Science (n=128), and Google Scholar (n=29) (See Appendix B). A total of 105 duplicates were removed prior to the screening process. Out of 401 studies included in the screening process, 298 were removed based on the title and abstract. Finally, after thoroughly screening the studies, only 52 studies met the inclusion criteria for the systematic review.

Study Characteristics

The reviewed characteristics were study design, author year, country of research, number of participants along with their gender, selected population, duration of the study, diagnostic criteria used in the study, and the reported prevalence (Table 1). This systematic review included 52 cross-sectional studies from different countries of the Arab world (Saudi Arabia, Jordan, Egypt, Lebanon, Bahrain, Oman, and Tunisia) cumulating a total of 51,683 participants. All the included studies were cross-sectional studies. The sample sizes within these studies vary from the smallest at 40 [15] to the largest being 14268 [16] participants. Male and female representation across these studies display substantial variations from a full male cohort in the study of Alshahrani et al. [17] to the absence of male participants in Alharbi et al. [18] and Alanzi et al. [19].

Table 1. Characteristics of the included studies.

IBS: irritable bowel syndrome

  Design Country Number of Participants Gender Duration of the Study Selected Population Diagnostic Criteria Prevalence of IBS
Alawi et al. (2024) [34] Cross-sectional Bahrain 492 Both One month Adults (+18) of Bahrain Rome IV criteria 18.3%
Zedan et al. (2024) [15] Cross-sectional Egypt 40 Both _ Undergraduate physiotherapy students Rome IV criteria 25%
ElSharawy et al. (2022) [54] Cross-sectional Egypt 182 Both N/A Medical students Rome III criteria 27.5%
Elhosseiny et al. (2019) [46] Cross-sectional Egypt 400 Both October 2018 to February 2019 Medical students Rome III criteria 31.7%
Abdel-Qader et al. (2024) [57] Cross-sectional Jordan 1042 Both July to September 2023 Adult population Rome IV criteria 41.7%
Jadallah et al. (2022) [41] Cross-sectional Jordan 1135 Both January to April 2020 1st to 6th-year medical students Rome III criteria 30.9%
Farah et al. (2022) [29] Cross-sectional Jordan 585 Both January to September 2018 Medical students of basic and clinical years Rome IV criteria 13%
Al-shdaifat et al. (2019) [33] Cross-sectional Jordan 163 Both March 2017 Students of Hashemite University Rome III criteria 16%
Yazbek et al. (2023)  [23] Cross-sectional Lebanon 425 Both June to December 2022 Lebanese adults (+18 years old) Rome IV criteria 46.8%
AlMutori et al. (2020) [50] Cross-sectional Oman 464 Both June to July 2017 University students Rome IV criteria 38.9%
Alshaikh et al. (2024) [51] Cross-sectional analytical Saudi Arabia 379 Both November and December 2023 Students of Saudi Arabian Universities Rome IV questionnaire 31.9 %
Almuzaini et al. (2024) [35] Cross-sectional descriptive Saudi Arabia 402 Both October 2020 Adult residents of the Qassim region Rome IV criteria 21.4%
Aljahdli et al. (2024) [36] Cross-sectional web-based survey Saudi Arabia 1346 Both February to May 2021 Patients diagnosed with IBS Rome IV criteria 26.4%
Alhazmi et al. (2024) [52] Cross-sectional, observational, descriptive Saudi Arabia 637 Both _ The general population of Jezan _ 31.08%
Alnasser et al. (2023) [37] Cross-sectional  observational Saudi Arabia 279 Both November 2022 Adults with Saudi citizenship Rome III criteria 17.6%
Hafiz et al. (2023) [24] Cross-sectional Saudi Arabia 936 Both November 2022 to May 2023 Adults of Makkah region (age 25 to 55 years) Rome IV criteria 44.9%
Alshahrani et al. (2023) [25] Cross-sectional Saudi Arabia 1622 Both April to June 2021 Adult citizens of Saudi Arabia Rome III criteria 43.6%
Mohammed et al. (2023) [48] Cross-sectional Saudi Arabia 600 Both September 2021 to January 2022 Undergraduate University students Rome III criteria 20.30%
Agwa et al. (2023) [61] Cross-sectional Saudi Arabia 452 Both July 2023 to July 2023 College students between the ages of 18 to 29 years Rome IV criteria 36.9%
Alhammadi et al. (2023) [58] Cross-sectional Saudi Arabia 683 Both 5 September  to 10 October 2022 Population of Asser region Rome IV criteria 39.97%
Mujamammi et al. (2023) [59] Cross-sectional and analytical Saudi Arabia 426 Both November to December 2020 Students of King Saud University Rome IV criteria 17.8%
AA et al. (2023) [62] Cross-sectional Saudi Arabia 450 Both October 2021 to March 2022 Secondary school teachers Rome III criteria 19.4%
Aghamdi et al. (2023) [38] Observational cross-sectional Saudi Arabia 402 Both July 2022 to January 2023 Medical students from several universities Rome IV criteria 18.7%
Al-Zahrani et al. (2022) [63] Cross-sectional Saudi Arabia 303 Both October and November 2021 Medical students of the University Rome IV criteria 33%
Alharbi et al. (2022) [8] Cross-sectional Saudi Arabia 921 Both February to April 2022 General population of Makkah city Rome IV criteria 20.19%
Alfaqih et al. (2022) [31] Cross-sectional Saudi Arabia 290 Both January to March 2022 Medical students Rome IV criteria 14.8%
Basharat et al. (2022) [39] Cross-sectional Saudi Arabia 6300 Both June to November 2022 General population Rome IV criteria 23.81%
Alharbi et al. (2022) [18] Cross-sectional Saudi Arabia 401 Females June and July 2021 Secondary school students Rome IV criteria 21.4%
Alqahtani et al. (2022) [49] Cross-sectional Saudi Arabia 1680 Both June to November 2019 General population Rome IV criteria 18.2%
Alqumayzi et al. (2022) [40] Cross-sectional Saudi Arabia 384 Both November 2021 to December 2022 Medical students Rome IV criteria 39.6%
Mirghani et al. (2022) [53] Cross-sectional Saudi Arabia 215 Both June and July 2021 Medical students Rome III criteria 22.80%
Fadl et al. (2022) [21] Cross-sectional Saudi Arabia 300 Both January to February 2021 Undergraduate medical students Rome III criteria 49.3%
Abdulrahman et al. (2022) [64] Cross-sectional Saudi Arabia 2802 Both March to June 2021 General population Rome IV criteria 16.4%
Alreshidi et al. (2022)  [60] Cross-sectional Saudi Arabia 308 Both November 2021 to December 2022 Medical students of Hail University Rome IV criteria 21.5%
Issa et al. (2022) [10] Cross-sectional Saudi Arabia 542 Both August 2021 to July 2022 Young adults of Jeddah _ 18.5%
Selim et al. (2022) [22] Cross-sectional Saudi Arabia 806 Both December 2019 to March 2020 General population Rome IV criteria 46.15%
Alanzi et al. (2021) [19] Cross-sectional Saudi Arabia 230 Females April to December 2019 High school female teachers Rome IV criteria 54.8%
Hussein et al. (2021)  [26] Cross-sectional Saudi Arabia 1319 Both November 2021 to February 2020 General adult population Rome IV criteria 7.9%
Basharat (2021) [42] Cross-sectional Saudi Arabia 578 Both _ Teachers working in different schools Rome Criteria 35.5%
Alshahrani et al. (2020) [17] Cross-sectional Saudi Arabia 400 Males  February 2020 Male students of secondary schools Rome IV criteria 39.80%
Arishi et al. (2020) [43] Cross-sectional Saudi Arabia 1554 Both January to March 2020 Adult general population Rome IV criteria 16%
Aljammaz et al. (2020) [44] Cross-sectional Saudi Arabia 426 Both March to May 2019 General population Rome III criteria 30.5%
AlButaysh et al. (2020) [32] Cross-sectional Saudi Arabia 290 Both February to June 2018 Medical students Rome IV criteria 14.8%
Ahmed et al. (2020) [30] Cross-sectional Saudi Arabia 472 Both October 2019 to January 2020 Medical students Rome IV criteria 12.6%
Wani et al. (2020)  [47] Cross-sectional Saudi Arabia 181 Both January to March 2016 University students _ 29.80%
AlAmeel et al. (2020) [45] Cross-sectional Saudi Arabia 594 Both May and June 2018 Board-certified surgeons and physicians Rome IV criteria 16.3%
Aljasser et al. (2020) [55] Cross-sectional Saudi Arabia 246 Both _ Medical students _ 35%
Taha et al. (2019) [56] Cross-sectional Saudi Arabia 205 Both _ Primary healthcare workers Rome IV criteria 16.1%
Hakami et al. (2019) [27] Cross-sectional Saudi Arabia 890 Both March 2017 to May 2018 General population Rome IV criteria 8.8%
Alharbi et al. (2019) [28] Cross-sectional Saudi Arabia 920 Both October 2018 to February 2019 General population Rome IV criteria 11.8%
Gallas et al. (2022) [20] Cross-sectional Tunisia 343 Both February to March 2015 Medical students Rome III criteria 7.6%
Alotaibi et al. (2023) [16] Cross-sectional observational United Arab Emirates 14268 Both 2021 to 2022 Graduates and undergraduates of United Arab Emirates University N/A 39%
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The prevalence of IBS among these studies was variable ranging from 7.6% [20] to 54.8% [19]. The average prevalence across these studies is approximately 27%. High prevalence rates of more than 40% were seen among the undergraduate medical students of Saudi Arabia (49.3%) [21], the general population of Saudi Arabia (46.15%) [22], adults of Lebanon (46.8%) [23], adults of Makkah (44.9%) [24], and among the adult citizens of Saudi Arabia (43.6%) [25].

Low prevalence was seen in the adult general population of Saudi Arabia ((7.9%) [26], 8.8% [27], and 11.8% [28]), medical students of Jordan (13%) [29], medical students of Saudi Arabia (12.6% [30] and 14.8% [31,32]) University students of Jordan (16%) [33]. The majority of the studies presented IBS prevalence rates were predominant in females [15,21,23,24,26,28,30,33-46] while two out of 52 studies presented male predominance in IBS prevalence rates [31,47].

Family history was a strong risk factor for IBS in various studies [15-18,24,29,32-35,46,48-50]. Anxiety and depression were also reported as the major contributors [8,16,22,23,27,29,38,41,43,44,46,48-57]. Among the least common risk factors are gastroesophageal reflux diseases [49], low income [26], diabetes mellitus [17], low water intake [28], workload [42,45], and occupation [24]. abdominal pain [15,35]. Other factors that were involved significantly in the high prevalence rate of IBS were food allergy [23,24,35,49,54], smoking [23,27,30,39,43,47-49,57], age [24,29,37,58,59], chronic diseases [18,24,42,48], and stress [8,22,31,32,39,43,49,60].

Discussion

IBS is a chronic functional bowel disease that is described by altered stool frequency or form associated with abdominal pain and discomfort. Estimation of the worldwide prevalence of IBS is imperative for understanding the burden and distribution of the disease. The incidence and prevalence of IBS have been studied systematically but there are significant variations in the results that may be due to the designs of the study or due to geographical regions. Variations can also occur due to different methods, sampling approaches, questionnaire types, variations due to local factors, and the use of dissimilar diagnostic criteria [65].

This systematic review was aimed at reviewing the prevalence of IBS in the Arab nations. This systematic review was based on 52 studies published from 2019 to 2024 in different Arab countries. The studies included diverse populations ranging from students, medical students, school teachers, adults, and the general population of different countries. All the included studies were cross-sectional and followed Rome III and Rome IV diagnostic criteria. The range of sample size was also vast, ranging from 40 to 14268. The IBS prevalence among the included studies was variable, ranging from 7.6% to 54.8%. The average IBS prevalence across these studies was approximately 27%.

The findings of our study were in line with a recent systematic review conducted for the assessment of the prevalence of IBS in the Kingdom of Saudi Arabia including 20 studies with a total of 1708 participants. This study found that the prevalence rates for IBS in the included studies ranged from 7.9% to 49.3% and the average incidence across these studies was about 24%. The factors highlighted by this study to be significantly related to the high prevalence of IBS were female gender, anxiety, depression, emotional stress, and family history [66]. A similar systematic review and meta-analysis based on 38 studies and 26,567 cumulative participants reported a pooled prevalence of IBS (20.7%) in the Saudi population [9].

Compared to our systematic review, a much lower prevalence has been reported by Oka et al. [65]. Their systematic review assessed the global prevalence of IBS and included 57 studies. The observed prevalence of IBS in studies that used Rome III diagnostic criteria was 9.2% compared with 3.8% who used Rome IV diagnostic criteria. The most commonly reported type of IBS in this systematic review was the mixed type. Moreover, the prevalence of IBS was higher in women as reported in most of the studies in our review. The prevalence was variable in different countries. This variability in prevalence persisted even when similar diagnostic criteria were used with identical procedures. However, this systematic review indicated a substantially low incidence with Rome IV criteria indicating that more restrictive standards can be less appropriate for population-based prevalence surveys [65]. A population-based study conducted in Iran found a very low 1.1% prevalence of IBS. The factors that were associated significantly were older age and marital status like some of the reported studies in the current review [67]. However, this study was published in 2009. This also indicates an increase in IBS prevalence in the region.

As reported in the present systematic review, the higher prevalence of IBS in women has been reported previously as well. A systematic review and meta-analysis by Lovell et al. reported an odds ratio of 1.67 in women compared to men regarding IBS [68]. Male predominance was also observed in two of the included studies in this systematic review [31,47]. Most of the global prevalence-reported studies marked a female predominance for IBS. It is believed sex hormones may promote gender differences by affecting stress hormones, immune response, gut-brain interactions, intestinal barrier functionality, and gut microbiome [69]. In their systematic review, Saito et al. found that the incidence of IBS in North America ranges from 3% to 20% [70]. The prevalence estimates ranged from 10% to 15% in most of the included studies. In their meta-analysis, Lovell et al. used Rome I and II criteria and found that the prevalence values were 8.8% and 9.4% respectively. Like other studies, this prevalence was higher in females than males. Also, the reported prevalence was lower in older adults and high in younger adults [71].

The most common risk factors found, in most of the studies included in the current systematic review, to be significantly associated with high prevalence rates of IBS were similar to the findings of the previous studies specifically designed to find the risk factors for IBS [72,73]. Depression and anxiety were considered to be the main culprits behind the progression of IBS. This is also evident from our study as several of the included studies found a significant association of depression and anxiety with IBS. On the other hand, IBS can also result in depression and anxiety in individuals. This was evidenced by Zamani et al. in their systematic review [74]. They found that the prevalence rates of anxiety disorders and symptoms in individuals suffering from IBS were 39.1% and 23%, respectively. Depressive disorders and symptoms were calculated to be 28.8% and 23.3%, respectively. These prevalence rates were an indication that patients with IBS have 3 increased odds of depression and anxiety compared to healthy subjects.

The majority of studies included in this systematic review included students of universities. This can be due to the limitation of the methodology as the majority of the studies used a cross-sectional study design. Furthermore, the high prevalence of IBS in students as reported in most studies can be due to stress-related factors. A systematic review that assessed the prevalence of IBS in medical students reported that IBS incidence ranges from 9.3% to 35.5% [75]. The prime factor for this high prevalence was a stressful environment in addition to the female gender, emotional disorders, anxiety, dietary habits, poor sleep, depression, and poor quality of sleep. Another systematic review was conducted for the assessment of the prevalence of IBS in Chinese university students [76]. This systematic review reported a pooled prevalence of IBS to be 11.89%. However, this prevalence was variable among the different diagnostic criteria used in the study. The highest prevalence of IBS was 17.66% in North China and the lowest was 3.18% in South China. Similar to the current review, this study also indicated that anxiety, depression, gender, and smoking behaviors were significantly associated with the prevalence of IBS. This study did not find any definite link between caffeine to IBS, but there was a marginal rise in the risk linked with its use [77].

Conclusions

The prevalence of IBS shows significant variability across different populations and countries. The female predominance in IBS prevalence was a consistent observation across a majority of the studies reviewed. Several risk factors identified included gastroesophageal reflux disease, low income, diabetes mellitus, low water intake, workload, occupation, food allergy, smoking, age, chronic diseases, and stress.

Appendices

Appendix A

Table 2. Combination of search terms used for literature search.

TI: title; AB: abstract; MeSH: medical subject headings

Search terms used
#1 Distribution [TI/AB] #14 Middle East  [MeSH] #27 Palestine [TI/AB]
#2 Epidemiology [TI/AB] #15 Middle East  [TI/AB] #28 Qatar [TI/AB]
#3 Incidence [TI/AB] #16 Bahrain [TI/AB] #29 Saudi Arabia [TI/AB]
#4 Prevalence [TI/AB] #17 Djibouti [TI/AB] #30 Somalia [TI/AB]
#5 OR/1-4 #18 Egypt [TI/AB] #31 Sudan [TI/AB]
#6 Irritable bowel syndrome [TI/AB] #19 Iran [TI/AB] #32 Syria [TI/AB]
#7 IBS [TI/AB] #20 Iraq [TI/AB] #33 Tunisia [TI/AB]
#8 Spastic Colon [TI/AB] #21 Jordan [TI/AB] #34 United Arab Emirates [TI/AB]
#9 Mucous Colitis [TI/AB] #22 Kuwait [TI/AB] #35 Yemen [TI/AB]
#10 Spastic Bowel syndrome [TI/AB] #23 Lebanon [TI/AB] #36 Arab world [TI/AB]
#11 Irritable colon [TI/AB] #24 Libya [TI/AB] #37 OR/14-36
#12 Functional Bowel Disease [TI/AB] #25 Morocco [TI/AB] #38 5 AND 13 AND 37
#13 OR/6-12 #26 Oman [TI/AB]  
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Appendix B

Table 3. Search results for the terms used in data search.

Key Variable Sub terms Search options PubMed CINAHL ultimate Web of Science Scopus
1. Prevelance 1.1 Distribution Title/Abstract 1,022,446 92464 3316754 4467525
1.2 Epidemiology Title/Abstract 271,132 43842 189400 243619
1.3 Incidence Title/Abstract 964,325 211246 1009927 1331650
1.4 Prevalence Title/Abstract 844,778 237884 874621 1050688
(((Distribution[Title/Abstract]) OR (Epidemiology[Title/Abstract])) OR (Incidence[Title/Abstract])) OR (Prevalence [Title/Abstract]) 2,849,135 536568 5161383 6791471
2. Irritable bowel syndrome   1.1 Irritable bowel syndrome Title/Abstract 17,118 4331 19333 20125
1.2 IBS Title/Abstract 12,183 2807 15830 17363
1.3 Spastic Colon Title/Abstract 63 10 109 240
1.4 Mucous Colitis Title/Abstract 26 5 311 571
1.5 Spastic Bowel syndrome Title/Abstract 51 1 29 81
1.6 Irritable colon Title/Abstract 451 40 1562 2362
  1.7 Functional Bowel Disease Title/Abstract 178 142 5509 7092
((((((Irritable bowel syndrome[Title/Abstract]) OR (IBS[Title/Abstract])) OR (Spastic Colon [Title/Abstract])) OR (Mucous Colitis [Title/Abstract])) OR (Spastic Bowel syndrome [Title/Abstract])) OR (Irritable colon [Title/Abstract])) OR (Functional Bowel Disease[Title/Abstract]) 20,152 5100 30355 32919
3. Arab world     3.1 Middle East Mesh 168,354      
3.2 Middle East Title/Abstract 17,997 4186 59290 90409
3.3 Bahrain Title/Abstract 1452 124 3146 6559
3.4 Djibouti Title/Abstract 481 71 865 1351
3.5 Egypt Title/Abstract 19894 3211 54359 77453
3.6 Iran Title/Abstract 57695 21468 114646 165955
3.7 Iraq Title/Abstract 9308 4168 25634 50399
3.8 Jordan Title/Abstract 9546 3568 33377 46696
3.9 Kuwait Title/Abstract 4651 1200 10184 16871
3.10 Lebanon Title/Abstract 6775 2174 13355 1800
3.11 Libya Title/Abstract 1655 327 5883 10035
3.12 Morocco Title/Abstract 8061 1167 26308 36707
3.13 Oman Title/Abstract 4332 1123 11612 17989
3.14 Palestine Title/Abstract 2389 930 12081 15445
3.15 Qatar Title/Abstract 3695 1222 7082 12262
3.16 Saudi Arabia Title/Abstract 29932 5936 49061 62848
3.17 Somalia Title/Abstract 1975 572 4267 6711
3. 18 Sudan Title/Abstract 10207 1600 19969 26167
3.19 Syria Title/Abstract 3261 913 12267 18235
3.20 Tunisia Title/Abstract 8671 897 20513 26950
3.21 United Arab Emirates Title/Abstract 4187 1230 9101 14583
3.22 Yemen Title/Abstract 2456 634 5531 8416
3.23 Arab world Title/Abstract 835 325 6769 12349
(((((((((((((((((((((("Middle East"[Mesh]) OR (Middle East[Title/Abstract])) OR (Bahrain[Title/Abstract])) OR (Djibouti[Title/Abstract])) OR (Egypt[Title/Abstract])) OR (Iran[Title/Abstract])) OR (Iraq[Title/Abstract])) OR (Jordan[Title/Abstract])) OR (Kuwait[Title/Abstract])) OR (Lebanon[Title/Abstract])) OR (Libya[Title/Abstract])) OR (Morocco[Title/Abstract])) OR (Oman[Title/Abstract])) OR (Palestine[Title/Abstract])) OR (Qatar[Title/Abstract])) OR (Saudi Arabia[Title/Abstract])) OR (Somalia[Title/Abstract])) OR (Sudan[Title/Abstract])) OR (Syria[Title/Abstract])) OR (Tunisia[Title/Abstract])) OR (United Arab Emirates[Title/Abstract])) OR (Yemen[Title/Abstract])) OR (Arab world[Title/Abstract]) 291220 53012 458862 654050
(((((((((((((((((((((((("Middle East"[Mesh]) OR (Middle East[Title/Abstract])) OR (Bahrain[Title/Abstract])) OR (Djibouti[Title/Abstract])) OR (Egypt[Title/Abstract])) OR (Iran[Title/Abstract])) OR (Iraq[Title/Abstract])) OR (Jordan[Title/Abstract])) OR (Kuwait[Title/Abstract])) OR (Lebanon[Title/Abstract])) OR (Libya[Title/Abstract])) OR (Morocco[Title/Abstract])) OR (Oman[Title/Abstract])) OR (Palestine[Title/Abstract])) OR (Qatar[Title/Abstract])) OR (Saudi Arabia[Title/Abstract])) OR (Somalia[Title/Abstract])) OR (Sudan[Title/Abstract])) OR (Syria[Title/Abstract])) OR (Tunisia[Title/Abstract])) OR (United Arab Emirates[Title/Abstract])) OR (Yemen[Title/Abstract])) OR (Arab world[Title/Abstract])) AND (((((((Irritable bowel syndrome[Title/Abstract]) OR (IBS[Title/Abstract])) OR (Spastic Colon [Title/Abstract])) OR (Mucous Colitis [Title/Abstract])) OR (Spastic Bowel syndrome [Title/Abstract])) OR (Irritable colon [Title/Abstract])) OR (Functional Bowel Disease[Title/Abstract]))) AND ((((Distribution[Title/Abstract]) OR (Epidemiology[Title/Abstract])) OR (Incidence[Title/Abstract])) OR (Prevalence [Title/Abstract])) 182 33 128 134
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Disclosures

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following:

Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work.

Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work.

Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Author Contributions

Concept and design:  Omar Almansour

Acquisition, analysis, or interpretation of data:  Omar Almansour

Drafting of the manuscript:  Omar Almansour

Critical review of the manuscript for important intellectual content:  Omar Almansour

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