Prevalence and Burden of Disorders of Gut-Brain Interaction Among UK Medical Students

Authors

  • Lydia C. Brown Third-year Medical Student. University of Sheffield, United Kingdom
  • Imran Aziz Academic Unit of Gastroenterology, Sheffield Teaching Hospitals & University of Sheffield, United Kingdom

DOI:

https://doi.org/10.5195/ijms.2024.2449

Keywords:

Disorders of Gut‐Brain Interaction, Functional Gastrointestinal Disorders, Psychological Distress, Burnout , Gut-Brain Interaction, Medical Students, Prevalence, Health Surveys, Questionnaires, Anxiety, Depression, Eating Disorders, Quality of Life, Burnout, Professional, Somatic Symptom Disorders, Rome IV Criteria, Irritable Bowel Syndrome, Functional Dyspepsia, Healthcare Utilization, United Kingdom, Cross-Sectional Studies, Mental Health

Abstract

Background: Disorders of Gut-Brain Interaction (DGBI) affect 40% of the general population and are associated with substantial health impairment. Medical students reportedly have among the highest rates of DGBI, although data is mainly from Asia and Africa. We addressed this issue within a UK-based university.

Methods: An online survey was completed by 378 of 1621 medical students. Demographics, medical history, and gastrointestinal symptoms were collected, the latter using a modified Rome IV questionnaire to determine the presence of DGBI symptoms over the last 3 months. Additional validated questionnaires screened for somatization, psychological distress, eating disorders, quality of life, and burnout.

Results: DGBI were present in 76% (n=289/378), of which two-of-three had multiple affected sites. The most frequent DGBI were gastroduodenal (57%), followed by bowel (49%), esophageal (29%), and anorectal (26%) disorders. Approximately 50% of students with DGBI experienced painful gastrointestinal symptoms at least one day/week. Students with DGBI, compared to those without, had significantly higher anxiety and depression scores, increased somatic symptom reporting, reduced mental and physical quality of life, poorer eating habits, and more frequent medication use (p-values, all<0.05). They were also at significantly higher risk of burnout, through study exhaustion and disengagement. The greatest health impairment was seen in those with multiple, painful, DGBI. Only 23% and 5% of students with DGBI had consulted a primary care provider and gastroenterologist, respectively.

Conclusion: Medical students commonly experience DGBI and associated health burden, yet infrequently seek help. Greater awareness may lead to increased support, improved health, and better study engagement.

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References

Drossman DA, Hasler WL. Rome IV—Functional GI Disorders: Disorders of Gut-Brain Interaction. Gastroenterology. 2016;150(6):1257-61.

Sperber AD, Bangdiwala SI, Drossman DA, Ghoshal UC, Simren M, Tack J, et al. Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Resultsof Rome Foundation Global Study. Gastroenterology. 2021;160(1):99-114.e3.

Aziz I, Palsson OS, Törnblom H, Sperber AD, Whitehead WE, Simrén M. The prevalence and impact of overlapping Rome IV-diagnosed functional gastrointestinal disorders on somatization, quality of life, and healthcare utilization: A cross-sectional general populationstudy in threecountries. Am J Gastroenterol. 2018;113(1):86-96.

Staller K, Abber SR, Burton Murray H. The intersection between eating disorders and gastrointestinal disorders: a narrative review and practical guide. Lancet Gastroentero lHepatol. 2023;8(6):565-78.

Molodynski A, Lewis T, Kadhum M, Farrell SM, LemtiriChelieh M, Falcão De Almeida T, et al. Cultural variations in wellbeing, burnout and substance use amongst medical students in twelve countries. Int Rev Psychiatry. 2021;33(1-2):37-42.

Kadhum M, Ayinde OO, Wilkes C, Chumakov E, Dahanayake D, Ashrafi A, et al. Wellbeing, burnout and substance use amongst medical students: A summary of results from nine countries. Int J Soc Psychiatry. 2022;68(6):1218-22.

Palsson OS, Whitehead WE, Van Tilburg MAL, Chang L, Chey W, Crowell MD, et al. Development and Validation of the Rome IV Diagnostic Questionnaire for Adults. Gastroenterology. 2016;150(6):1481-91.

Morgan JF, Reid F, Lacey JH. The SCOFF Questionnaire: Assessmentof a New Screening Tool for Eating Disorders. BMJ. 1999;319(7223):1467-8.

Hill LS, Reid F, Morgan JF, Lacey JH. SCOFF, the development of an eating disorder screening questionnaire. Int J Eat Disord. 2010;43(4):344-51.

Spiller RC, Humes DJ, Campbell E, Hastings M, Neal KR, Dukes GE, et al. The Patient Health Questionnaire 12 Somatic Symptom scale as a predictor ofsymptomseverity and consultingbehaviour in patientswith irritable bowelsyndrome and symptomatic diverticular disease. Aliment Pharmacol Ther. 2010;32(6):811-20.

Zigmond AS, Snaith RP. The Hospital Anxiety and DepressionScale. Acta Psychiatr Scand. 1983;67(6):361-70.

Ware JE, Kosinski M, Dewey JE, Gandek B. How to score and interpret single-item health status measures: a manual for users of the SF-8 health survey. Lincoln, RI: Quality Metric Incorporated. 2001;15(10):5.

Demerouti E, Bakker AB. The Oldenburg Burnout Inventory: A good alternative to measure burnout and engagement. Handbook of stress and burnout in health care. 2008;65(7):1-25.

Luo Y, Camey SA, Bangdiwala SI, Palsson OS, Sperber AD, Keefer LA. Global patterns of prescription pain medication usage in disorders of gut–braininteractions. Neurogastroenterol Motil. 2023;35(1):e14457.

Zia JK, Lenhart A, Yang PL, Heitkemper MM, Baker J, Keefer L, et al. Risk Factors for Abdominal Pain-Related Disorders of Gut-Brain Interaction in Adults and Children: A Systematic Review. Gastroenterology. 2022;163(4):995-1023.e3.

Tan Y-M, Goh KL, Muhidayah R, Ooi CL, Salem O. Prevalence of irritable bowel syndrome in young adult Malaysians: A survey among medical students. J Gastroenterol Hepatol. 2003;18(12):1412-6.

Gallas S, Knaz H, Methnani J, Maatallah Kanzali M, Koukane A, Bedoui MH, et al. Prevalence and risk factors of functional gastrointestinal disorders in early period medical students: a pilot study in Tunisia. Libyan J Med. 2022;17(1).

Jafri W, Yakoob J, Jafri N, Islam M, Ali QM. Frequency of irritable bowel syndrome in college students. J Ayub Med Coll Abbottabad. 2005;17(4):9.

Shahaf-Oren B, Madan I, Henderson C. “A lot of medical students, their biggest fear is failing at being seen to be a functional human”: disclosure and help-seeking decisions by medical students with health problems. BMC Med Educ. 2021;21(1):1-599.

Menon V, Sarkar S, Kumar S. A cross-sectional analysis of barriers to health-care seeking among medical students across training period. J Ment Health Hum Be. 2017;22(2):97-103.

Simons J, Shajee U, Palsson O, Simren M, Sperber AD, Törnblom H, et al. Disorders of gut-brain interaction: Highly prevalent and burdensome yet under-taught within medical education. United European Gastroenterol J. 2022;10(7):736-44.

Farrell SM, Kadhum M, Lewis T, Singh G, Penzenstadler L, Molodynski A. Wellbeing and burnout amongst medical students in England. Int Rev Psychiatry. 2019;31(7-8):579-83.

Farrell SM, Molodynski A, Cohen D, Grant AJ, Rees S, Wullshleger A, et al. Wellbeing and burnout among medical students in Wales. Int Rev Psychiatry. 2019;31(7-8):613-8.

Erschens R, Keifenheim KE, Herrmann-Werner A, Loda T, Schwille-Kiuntke J, Bugaj TJ, et al. Professional burnout among medical students: Systematic literature review and meta-analysis. Med Teach. 2019;41(2):172-83.

Hod K, Melamed S, Dekel R, Maharshak N, Sperber AD. Burnout, butnotjobstrain, isassociatedwith irritable bowelsyndrome in workingadults. J Psychosom Res. 2020;134:110121-.

Patacchioli FR, Angelucci L, Dell’Erba G, Monnazzi P, Leri O. Actual stress, psychopathology and salivary cortisol levels in the irritable bowelsyndrome (IBS). J Endocrinol Invest. 2001;24(3):173-7.

Jahrami H, Sater M, Abdulla A, FarisMeA-I, AlAnsari A. Eatingdisordersriskamong medical students: a global systematicreview and meta-analysis. Eat Weight Disord. 2019;24(3):397-410.

Hodkinson A, Zhou A, Johnson J, Geraghty K, Riley R, Zhou A, et al. Associations of physician burnout with career engagement and quality of patient care: systematic review and meta-analysis. BMJ. 2022;378:e070442.

Goyal O, Nohria S, Dhaliwal AS, Goyal P, Soni RK, Chhina RS, et al. Prevalence, overlap, and risk factors for Rome IV functional gastrointestinal disorders among college students in northern India. Indian J Gastroenterol. 2021;40(2):144-53.

Bogowicz P, Ferguson J, Gilvarry E, Kamali F, Kaner E, Newbury-Birch D. Alcohol and other substance use among medical and law students at a UK university: a cross-sectional questionnaire survey. Postgrad Med J. 2018;94(1109):131-6.

The image is a Venn diagram illustrating the overlap between different anatomical regions affected by Disorders of Gut Brain Interaction (DGBI) among medical students. There are three circles representing oesophageal disorders (blue), gastroduodenal disorders (green), and bowel disorders (yellow), with varying degrees of overlap. The total number of students surveyed is 289, with 110 (38%) having oesophageal disorders, 214 (74%) with gastroduodenal, and 184 (64%) with bowel disorders. Central to the diagram is a shared intersection showing 13% of students with conditions affecting all three regions. Surrounding this are sections where two regions overlap, indicating smaller percentages of students with disorders in two regions. Each circle also contains areas with no overlap, specifying the proportion of students with conditions unique to that anatomical region.

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Published

2024-03-25 — Updated on 2024-04-12

How to Cite

Brown, L. C., & Aziz, I. (2024). Prevalence and Burden of Disorders of Gut-Brain Interaction Among UK Medical Students. International Journal of Medical Students, 12(1), 43–52. https://doi.org/10.5195/ijms.2024.2449

Issue

Vol. 12 No. 1 (2024)

Section

Original Article

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