Endoscopic findings and prevalence of Helicobacter pylori among dyspeptic patients in Nepal: A cross-sectional study

Endoscopic findings and prevalence of Helicobacter pylori among dyspeptic patients in Nepal: A cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Endoscopic findings and prevalence of Helicobacter pylori among dyspeptic patients in Nepal: A cross-sectional study Aadesh Rayamajhi, Mohan Bhusal, Saraddha Pandey, Sandesh Rayamajhi, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7311683/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Dyspepsia is a prevalent gastrointestinal issue with a variety of underlying causes, which can range from functional disorders to significant organic diseases. The objective of this study was to identify the underlying causes of dyspepsia by evaluating the prevalence of Helicobacter pylori infection and examining associated endoscopic and histopathological findings in affected patients. Methods A cross-sectional study involving 555 adult patients who presented with dyspepsia at two healthcare facilities in Nepal was carried out. All participants underwent upper gastrointestinal endoscopy, during which targeted biopsies were collected from the esophagus, stomach, and duodenum depending upon the endoscopic findings. Histological analysis via Giemsa stain was conducted to detect H. pylori. The relationships between H. pylori status and various clinical, endoscopic, and histopathological findings were assessed via chi-square tests. Results The average age of the participants was 45.7 ± 15.2 years, with a predominance of females (58.2%). The most common endoscopic finding was gastritis (93.0%), followed by hiatus hernia (65.8%), esophagitis (59.0%), ulcers (39.6%), duodenitis (27.9%), and erosions (13.0%). H. pylori infection was identified in 16.8% of the patients. The type of peptic ulcer differed significantly by sex (p = 0.040), with gastric ulcers occurring frequently in females and duodenal or mixed ulcers occurring more frequently in males. A statistically significant correlation was found between H. pylori infection and histopathologic characteristics, including active chronic gastritis (p < 0.01), inactive chronic gastritis (p < 0.01), and atrophy (p 0.05). Conclusion Organic abnormalities are frequently noted among patients with dyspepsia, with gastritis being the most prominent endoscopic feature. Although H. pylori infection strongly correlated with histologic indicators of chronic gastritis and atrophy, its association with endoscopic findings is limited. These findings underscore the importance of histopathological evaluation in the thorough assessment of dyspepsia. Atrophic gastritis cross-sectional study dyspepsia endoscopy histopathology Helicobacter pylori gastritis intestinal metaplasia Figures Figure 1 Figure 2 Figure 3 Figure 4 BACKGROUND Helicobacter pylori (HP), identified by Barry Marshall and Robin Warren in 1982, is a gram-negative extracellular bacterium that colonizes the human stomach, with recent evidence suggesting an intracellular propensity. This infection is widespread in developing nations with limited socioeconomic resources. It serves as a causative factor for a majority of upper gastrointestinal (UGI) diseases such as gastric inflammation (gastritis), peptic ulcer disease (10–20%), distal gastric adenocarcinoma (1–2%), and gastric mucosal-associated lymphoid tissue lymphoma (< 1%), contributing significantly to morbidity. 1 HP infection is not a disease by itself; instead, it gives rise to a spectrum of clinical disorders affecting not only the UGI tract and the hepatobiliary tract but also extragastrointestinal conditions such as iron-deficiency anemia, primary immune thrombocytopenia, and weak evidence of associations with various ophthalmic and dermatologic diseases. 2 Dyspepsia is the predominant symptom of HP infection. In accordance with the collaborative guidelines of the American College of Gastroenterology and the Canadian Association of Gastroenterology, dyspepsia is defined as the presence of predominant epigastric pain lasting for a minimum of one month. Any other UGI symptoms, such as epigastric fullness, nausea, vomiting, or heartburn, should accompany this pain. 3 Individuals with dyspepsia are more likely to be HP positive than asymptomatic individuals. 4 Diagnosing HP infection can involve invasive techniques that require endoscopy and biopsy (such as histological examination, culture, and rapid urease tests), as well as noninvasive methods including serology, the urea breath test, and the detection of HP antigen in urine or stool samples. 5 In numerous developing countries, access to facilities for UGI endoscopy (UGIE) is limited. Consequently, the diagnosis of UGI diseases relies primarily on clinical parameters in many cases. Incorrect or delayed diagnoses, leading to ineffective management, contribute to increased morbidity and economic losses for individuals. 6 Nevertheless, in numerous clinical situations, the gold standard approach is considered to be endoscopic biopsy followed by histological analysis. 7 The literature lacks information on the prevalence of HP infection in Nepal. Therefore, the main objective of this study was to ascertain the prevalence of HP infection among dyspeptic patients. In conjunction with these findings, this research aimed to investigate potential associations between Hp infection and various factors, including age and gender. Furthermore, this study aimed to explore the connections between Hp and both endoscopic and histopathological diagnoses. METHODS Study design and setting This retrospective study was a two-center-based cross-sectional descriptive study conducted at the gastroenterology outpatient department of Gastro Center, Butwal, Pvt. Ltd., a specialized clinic in Butwal, Nepal, and the endoscopy unit of the Department of Gastroenterology at Tribhuvan University Teaching Hospital. The study population included all patients who attended the gastroenterology clinic between July 2024 and December 2024, for various dyspeptic symptoms and subsequently underwent UGIE. Endoscopic evaluation was performed via an IMAGINA i10c endoscope (PENTAX MEDICAL), following standard procedures. Comprehensive endoscopic evaluations covered all anatomic regions of the esophagus, stomach, and the first and second parts of the duodenum. Mucosal biopsies were systematically obtained from the antrum, body of the stomach, and any suspicious lesions for histopathological examination. Specifically, two biopsies were taken from the antrum and one from the gastric body to facilitate accurate detection of HP. The histopathological diagnosis of HP infection in the biopsy sample was performed via Giemsa stain. Calculation of sample size Based on a study reported by Sardar et al., the prevalence of HP infection is 73.3%. 8 As the study was performed in an infinite population, the sample size (SS) was calculated as follows: $$\:\varvec{S}\varvec{S}=\frac{{\varvec{Z}}^{2}\left(\varvec{P}\right)\left(1-\varvec{P}\right)}{{\varvec{d}}^{2}}$$ Z = standard normal prevalence at 95% confidence interval (CI) = 1.96 p = prevalence rate = 73.3% = 0.733 d = precision = 0.05 According to the formula provided above, the study necessitates a minimum sample size of 301 participants. However, more patients were recruited to increase the power of the study. Eligibility criteria Patients eligible for inclusion were those who presented with undiagnosed dyspeptic symptoms and were aged 18 years and above. All patients had at least one symptom of dyspepsia, including belching, vomiting, postprandial fullness, early satiation, epigastric pain, or burning. Individuals with a preexisting diagnosis of HP, along with patients who had taken antibiotics and proton pump inhibitors (PPI) within two weeks before the endoscopic examination, were excluded from the study. Data collection and definitions The working definition of dyspepsia was based on the collaborative guidelines of the American College of Gastroenterology and the Canadian Association of Gastroenterology. Findings at endoscopy were recorded and categorized as esophagitis, hiatal hernia, esophageal stricture, gastritis, gastric erosions, gastric ulcer, gastric polyps, duodenitis, duodenal erosions, duodenal ulcer, duodenal stricture, biopsy-proven malignancy, and “others” for potential findings. A significant finding possibly related to dyspepsia was defined as esophagitis, gastritis, gastric or duodenal ulcers, or erosions, and suspected malignancy. The medical records of each patient were examined from the records of the endoscopy software and electronic histopathology reports, and relevant information about the objectives was extracted. The data collection included details about the patients' demographic profiles, including age, gender, and the diagnoses derived from both endoscopy and histopathological examinations. Statistical analysis The data were analyzed using the Statistical Package for Social Sciences − 26 (IBM, Armonk, NY, USA), The results are presented as the means ± standard deviations for quantitative variables and frequencies (percentages) for qualitative variables. Categorical variables were compared with Pearson’s chi-square test. A significant P value was taken as < 0.05 at the 95% CI. Graphical illustrations were generated using Microsoft Excel, 2016. Ethical Consideration The study received ethical approval from the Institutional Review Committee. This study conformed to the provisions of the Declaration of Helsinki. RESULTS A total of 555 patients were enrolled in the study. The mean age was 45.7 ± 15.2 years. Females comprised the majority of participants, accounting for 323 cases (58.2%), and 232 (41.8%) were male (M: F – 1:1.4). Gastritis was the most frequently observed endoscopic finding, and was present in 516 patients (93.0%), followed by hiatus hernia in 365 (65.8%) and esophagitis in 327 (58.9%). Ulcers were seen in 220 patients (39.6%), whereas duodenitis and erosions were noted in 155 (27.9%) and 72 (13.0%) patients, respectively. These results indicate a predominance of upper gastrointestinal inflammation and structural abnormalities in the study population (Fig. 1 ). Among the 555 dyspeptic patients, 327 (59.0%) had erosive esophagitis, with the majority presenting with mild grades (Los Angeles; LA-A and LA-B;). Only a few cases of severe esophagitis were noted, including one patient with LA-C and three with LA-D. Normal esophageal findings were observed in 210 patients (37.8%). Hiatus hernias were present in 365 patients (65.8%), accounting for nearly two-thirds of the cohort. Suspected Barrett’s esophagus and candidiasis were identified in seven patients each. Among the three patients with suspected esophageal malignancies, two were confirmed to have esophageal squamous cell carcinoma on biopsy. Additionally, one case each of an esophageal stricture and esophageal web was recorded (Table 1 ). Pangastritis emerged as the most prevalent gastric abnormality, identified in 287 patients (51.7%), followed by antral gastritis in 214 patients (38.6%). Gastric ulcers were documented in nearly one-third of the patients (n = 192, 34.5%), reflecting a considerable burden of mucosal injury. Gastric erosions and enterogastric reflux gastritis were observed in 26 and 15 patients, respectively. A macroscopically normal gastric mucosa was noted in only 10 individuals. Notably, three patients were endoscopically suspected of harboring a gastric malignancy, with histopathological confirmation of carcinoma in one patient (Table 1 ). Duodenal endoscopy was unremarkable in nearly half of the patients (n = 269, 48.5%). Duodenitis was identified in 155 individuals (27.9%), representing the most common abnormality, followed by duodenal ulcers, which were observed in 60 patients (10.8%). These findings highlight the modest prevalence of duodenal pathology among the dyspeptic cohort (Table 1 ). Table 1 Endoscopic findings observed in the esophagus, stomach, and duodenum among individuals presenting with dyspepsia Findings Frequency (N = 555) Percentage Esophagus Normal 210 37.8 Esophagitis 327 59.0 Hiatus Hernia 365 65.8 Barrett's 7 1.3 Candidiasis 7 1.3 Suspected Malignancy 3 0.6 Stricture 1 0.2 Web 1 0.2 Stomach Pangastritis 287 51.7 Antral Gastritis 214 38.6 Ulcer 192 34.5 Erosions 26 4.7 Enterogastric Reflux Gastritis 15 2.7 Polyp 31 5.6 Suspected Malignancy 3 0.5 Normal 10 1.8 Duodenum Normal 269 48.5 Duodenitis 155 27.9 Ulcer 61 10.9 Erosions 48 8.6 Stricture 5 0.9 Others 21 3.7 * The sum of these individual findings in the table is greater than this cumulative value because some patients had more than one particular finding. The study revealed a statistically significant relationship between gender and peptic ulcer type (p = 0.040). Females more often presented with gastric ulcers, whereas duodenal and combined gastric-duodenal ulcers predominated among males, suggesting gender-specific variations in ulcer localization (Table 2 ). However, the distribution of ulcer types did not differ significantly across age groups (p = 0.695). Table 2 Relationships of ulcer with gender Ulcer based on location Gender Absent Gastric ulcer Duodenal ulcer Gastric and duodenal ulcers Female 207 (61.7%) 90 (56.6%) 13 (46.4%) 13 (39.4%) Male 128 (38.2%) 69 (43.4%) 15 (53.5%) 20 (60.6%) The total prevalence of HP among dyspeptic patients who underwent UGIE was 16.8% (n = 93) (Fig. 2 ). A chi-square test showed no statistically significant associations between HP infection status and gender (p = 0.666), indicating that infection rates did not differ meaningfully between males (15.9%) and females (17.3%) (Fig. 3 ). The highest proportion of HP positivity was observed in the 25–34 age group (26.4%), followed by the 35–44 age group (16.9%). In contrast, individuals aged above 55 years had the lowest infection rate, with only 9.9% testing positive (Fig. 4 ). These findings suggest that HP infection is more prevalent among younger adults in this sample. The chi-square test revealed a statistically significant association between age group and HP infection status (p = 0.008). A statistically significant association was not detected between HP status and any of the listed endoscopic findings, including antral gastritis (p = 0.504), pangastritis (p = 0.983), duodenitis (p = 0.608), and ulcers (p = 0.233). Although a slightly greater percentage of ulcers and pangastritis were observed in HP-positive individuals than in HP-negative individuals, these differences were not statistically significant (Table 3 ). These findings suggest that while these conditions may coexist with HP infection, their presence alone does not reliably predict infection status based on endoscopic findings. Table 3 Association between H. pylori infection and common endoscopic findings among patients Endoscopic findings H. pylori P- value Positive Negative n = 93 (% within column) n = 462 (% within column) Antral Gastritis Present 33 (35.5%) 181 (39.2%) 0.504 Absent 60 (64.5%) 281 (60.8%) Pangastritis Present 48 (51.6%) 239 (51.7%) 0.983 Absent 45 (48.4%) 223 (48.3%) Duodenitis Present 28 (30.1%) 127 (27.5%) 0.608 Absent 65 (69.9%) 335 (72.5%) Ulcer Present 42 (45.2%) 178 (38.5%) 0.233 Absent 51 (54.8%) 284 (61.5%) There was a strong and statistically significant association between HP infection and the presence of active chronic gastritis, inactive chronic gastritis, and atrophy (p < 0.01 for all). Nearly 98% of HP-positive patients had active chronic gastritis, whereas only 40.3% of HP-negative individuals had active chronic gastritis. In contrast, inactive chronic gastritis was primarily observed in HP-negative patients (53.0%). Similarly, gastric atrophy was more common among those infected with HP (55.9% vs. 22.7%). However, the presence of intestinal metaplasia was not significantly associated with HP status (p = 0.721), suggesting that metaplasia may occur independently of active infection (Table 4 ). Table 4 Association between H. pylori infection and histopathological findings among patients Histopathologic findings H. pylori P- value Positive Negative n = 93 (% within column) n = 462 (% within column) Active Chronic Gastritis Present 91 (97.8%) 186 (40.3%) < 0.01 Absent 2 (2.2%) 276 (59.7%) Inactive Chronic Gastritis Present 2 (2.2%) 245 (53.0%) < 0.01 Absent 91 (97.8%) 217 (47.0%) Atrophy Present 52 (55.9%) 105 (22.7%) < 0.01 Absent 41 (41.1%) 357 (77.3%) Metaplasia Present 7 (7.5%) 40 (8.7%) 0.721 Absent 86 (92.5%) 422 (91.3%) DISCUSSION In this study, the ages of patients who presented with dyspepsia ranged from 18 to 87 years, with a mean age of 45.7 years. Among 555 patients enrolled, 323 (58.2%) were female, and 232 (41.8%) were male, yielding a male-to-female ratio of 1:1.4. Similar demographic patterns have been reported by K.C. et al. and Sharma et al., both of whom reported a mean patient age in their 40s and a female predominance, which is consistent with the findings of the present study. 9 , 10 Hence, dyspeptic symptoms were more prevalent in female patients. Organic causes of dyspepsia were identified in the majority of our cases, aligning with findings from a study conducted in India, where 87% of patients were reported to have organic etiologies of dyspepsia. 11 In our study, the most common endoscopic findings among dyspeptic patients were gastritis (92.9%), followed by hiatus hernia (65.8%), esophagitis (59.0%), ulcers (39.6%), duodenitis (27.9%), and erosions (12.9%). Similarly, Shrestha et al. reported gastritis as the predominant finding, which was observed in 60.2% of dyspeptic patients, followed by duodenitis in 4.4% of cases. 12 In contrast, K.C. et al. and Subedi et al. reported ulcers as the predominant endoscopic finding, followed by gastritis. 9 , 13 HP represents the most widespread bacterial infection globally, and is estimated to affect approximately 4.4 billion individuals—more than half of the world’s population. Its prevalence shows marked geographic variation, ranging from 30–50% in developed nations to as high as 85–95% in developing countries. 14 In the present study, the prevalence of HP infection among patients with dyspepsia was 16.7%. Comparable rates have been reported in previous studies, including 20.0% in Nepal by Chaudhary et al. and 16.4% in Japan among dyspeptic individuals. 15 , 16 The prevalence observed in our study was notably lower than that reported in similar studies conducted in various regions of Nepal, where the reported prevalence rates ranged from 32.9–68.1%. 12, 13 , 17 , 18 A substantially higher prevalence rate of 85.0% was reported in the neighboring country, India, in a study conducted by Agarwal et al. 11 A comprehensive systematic review and meta-analysis encompassing 184 studies across 62 countries reported the highest pooled prevalence of HP infection in Africa (70.1%) and the lowest in Oceania (24.4%). Southern Asia presented a prevalence of approximately 61.6%. Among individual countries, Nigeria reported the highest prevalence at 87.7%, whereas Switzerland had the lowest at 18.9%. 19 The disparity in prevalence observed in our study compared with previous reports may result from differing diagnostic methods, patient populations, hygiene standards, urban development, and socioeconomic status. In the present study, the prevalence of HP infection among female dyspeptic patients (17.3%) was slightly higher than that observed in male patients (15.9%), which contrasts with the findings reported by K.C. et al., where a higher prevalence was noted among males. 9 However, no statistically significant difference in HP prevalence was observed between genders, which is consistent with the findings reported by Agarwal et al. 11 The age distribution of HP infection in our study revealed a greater proportion of positive individuals aged 25–34 years (26.4%) and 35–44 years (16.9%), similar to the observations of Kaore et al., who reported a greater prevalence of infection in the 20–40-year age group than in older age groups. 20 The endoscopic findings in the present study, including antral gastritis, pangastritis, duodenitis, and ulcers, were not significantly associated with HP infection, which contrasts with the findings reported from central and eastern Nepal, where significant associations were observed. 12 , 17 This finding aligns with the understanding that endoscopic abnormalities are often multifactorial in origin and may not be specifically indicative of HP infection. Although procedural precautions—such as obtaining biopsies from multiple gastric sites and withholding PPIs before endoscopy—were implemented to optimize detection, factors including the presence of atrophic gastritis and intestinal metaplasia may have contributed to false-negative results. 21 The most common histopathological finding was active chronic gastritis, accounting for 49.9% of cases, followed by inactive chronic gastritis at 44.5%, in concordance with a study conducted by K.C. et al. 9 There was a strong, significant association between Hp infection and histopathological findings in our study, with active chronic gastritis (97.8%) and atrophy (55.9%) being more common in infected individuals, whereas inactive chronic gastritis predominated in those without infection (53.0%). In our study, atrophy and intestinal metaplasia were observed in 28.3% (157/555) and 8.5% (47/555) of dyspeptic patients, respectively—substantially higher than the 2.4% (24/1020) and 3.0% (31/1024) reported in another study. 9 This research has several significant strengths that increase its value and relevance. This study involved a large cohort of 555 dyspeptic patients from two healthcare institutions, enhancing the diversity and generalizability of the findings. Comprehensive endoscopic and histopathological assessments across the esophagus, stomach, and duodenum provided a broad view of upper gastrointestinal pathology. Histologic evaluation of gastric biopsies allows for meaningful correlation with HP status, and the identification of clinically significant conditions such as atrophy, metaplasia, and suspected malignancy adds to its practical relevance. Nevertheless, certain limitations must be acknowledged. The cross-sectional design limits the ability to establish causal relationships between HP infection and observed abnormalities. Functional dyspepsia was not assessed, and confounding factors such as nonsteroidal analgesic use, smoking, alcohol intake, or socioeconomic background were not considered, which may influence both the clinical and pathological findings. Despite these limitations, this study provides valuable and detailed insights into the organic causes of dyspepsia in a clinical setting. CONCLUSIONS This study highlights the substantial burden of endoscopic and histopathological abnormalities among individuals presenting with dyspepsia. While HP infection was not significantly associated with common endoscopic findings such as antral gastritis, pangastritis, duodenitis, or peptic ulcers, a strong and statistically significant association was observed between HP and histological features, particularly active chronic gastritis and gastric atrophy (p < 0.01). Gender-based differences in ulcer type were also noted, with females being more likely to present with gastric ulcers and males presenting with duodenal or mixed ulcers. These findings underscore the importance of combining histologic assessment with endoscopic evaluation for accurate diagnosis and targeted management of dyspeptic patients. Abbreviations CI: Confidence interval HP: Helicobacter pylori LA: Los Angeles PPI : Proton pump inhibitors UGI : Upper gastrointestinal UGIE : Upper gastrointestinal endoscopy Declarations Ethics approval and consent to participate The study was approved by the Institutional Review Committee (IRC) of Tribhuvan University (TU), Institute of Medicine (IOM) [Reference proposal number: 081/082 - 495]. Due to the retrospective study design, written informed consent was waived by IRC, TU, IOM. This study adhered to the Declaration of Helsinki and complied with the Declaration regarding human data and material. Consent for publication Not applicable. Availability of data and materials The datasets analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding No funding was received. Author’s Contribution: AR: Conceptualization, Methodology, Software, Data curation, Investigation, Validation, Formal analysis, Visualization, Project administration, Resources, Writing - original draft, Writing - review & editing; MB: Conceptualization, Methodology, Supervision, Visualization Resources, Writing - original draft, Writing - review & editing; SP, SR: Software, Data curation, Writing - original draft, Writing—review & editing; RP, PK: Conceptualization, Validation, Formal analysis, Writing - review & editing All authors read and approved the final manuscript. Acknowledgments No acknowledgement to be made. References Bauer B, Meyer TF. 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Afr Health Sci. 2006;6(2):98-103. Talebi Bezmin Abadi A. Diagnosis of Helicobacter pylori Using Invasive and Noninvasive Approaches. J Pathog. 2018;2018:9064952. Sardar M, Kumar D, Aakash F, Partab F, Kumar S, Barkha F, et al. Prevalence and etiology of Helicobacter pylori infection in dyspepsia patients: a hospital-based cross-sectional study. Ann Med Surg (Lond). 2023;85(4):665-9. Amatya GL, Koirala K, Lakhey A, K.C SR. Prevalence of Helicobacter pylori among patients with dyspepsia and correlation between endoscopic and histological diagnosis. Journal of Pathology of Nepal. 2016;6(11):942-6. Sharma SK, Maharjan DK, Thapa PB. Hospital based analytic study of peptic ulcer disease in patients with dyspeptic symptoms. Kathmandu Univ Med J (KUMJ). 2009;7(26):135-8. Agarwal PK, Badkur M, Agarwal R, Patel S. Prevalence of Helicobacter pylori infection in upper gastrointestinal tract disorders (dyspepsia) patients visiting outpatient department of a hospital of North India. 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Comparative evaluation of the diagnostic tests for Helicobacter pylori and dietary influence for its acquisition in dyspeptic patients: A rural hospital based study in central India. JCDR. 2012;6:636-41. Lee JY, Kim N. Diagnosis of Helicobacter pylori by invasive test: histology. Ann Transl Med. 2015;3(1):10. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7311683","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":498309933,"identity":"8da58174-c36d-4346-89c7-07a019ece727","order_by":0,"name":"Aadesh 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Rahul","middleName":"","lastName":"Pathak","suffix":""},{"id":498309941,"identity":"9029d028-b98a-4acd-be5a-bf1bf374a9f4","order_by":5,"name":"Pradip Kafle","email":"","orcid":"","institution":"Tribhuvan University Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Pradip","middleName":"","lastName":"Kafle","suffix":""}],"badges":[],"createdAt":"2025-08-06 16:23:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7311683/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7311683/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89994245,"identity":"ee89a2a9-8491-4327-8e12-5d0b713f0541","added_by":"auto","created_at":"2025-08-27 07:50:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":78695,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCommon endoscopic findings present in individuals with dyspepsia\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7311683/v1/b8c1bc26eca2297edff0426c.png"},{"id":89995713,"identity":"e8af46a2-98eb-4c35-9cd4-4ef4242267b2","added_by":"auto","created_at":"2025-08-27 07:58:12","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":104349,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePrevalence of H. pylori among dyspeptic patients who underwent endoscopy between July 2024 and December 2024\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7311683/v1/4f54c309025c9ea4b4c9b2a8.png"},{"id":89994244,"identity":"984823f1-7c76-4c1a-8cd5-2cbf53bffc40","added_by":"auto","created_at":"2025-08-27 07:50:12","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":47344,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGender distribution of H. pylori infection\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7311683/v1/2e7149f67e5f16183f689c38.png"},{"id":89994248,"identity":"22a3e98a-29c5-4d0a-935c-9d2644504029","added_by":"auto","created_at":"2025-08-27 07:50:12","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":71724,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAge distribution of H. pylori infection\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7311683/v1/b4f09efc6033cd94ff0e2a74.png"},{"id":107034487,"identity":"25043229-27d6-4e99-9add-40881e9209d3","added_by":"auto","created_at":"2026-04-16 03:55:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1157056,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7311683/v1/71c5b88d-7c9b-4c11-8a9e-403b7365bd69.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Endoscopic findings and prevalence of Helicobacter pylori among dyspeptic patients in Nepal: A cross-sectional study","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003e\u003cem\u003eHelicobacter pylori\u003c/em\u003e (HP), identified by Barry Marshall and Robin Warren in 1982, is a gram-negative extracellular bacterium that colonizes the human stomach, with recent evidence suggesting an intracellular propensity. This infection is widespread in developing nations with limited socioeconomic resources. It serves as a causative factor for a majority of upper gastrointestinal (UGI) diseases such as gastric inflammation (gastritis), peptic ulcer disease (10\u0026ndash;20%), distal gastric adenocarcinoma (1\u0026ndash;2%), and gastric mucosal-associated lymphoid tissue lymphoma (\u0026lt;\u0026thinsp;1%), contributing significantly to morbidity.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eHP infection is not a disease by itself; instead, it gives rise to a spectrum of clinical disorders affecting not only the UGI tract and the hepatobiliary tract but also extragastrointestinal conditions such as iron-deficiency anemia, primary immune thrombocytopenia, and weak evidence of associations with various ophthalmic and dermatologic diseases.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Dyspepsia is the predominant symptom of HP infection. In accordance with the collaborative guidelines of the American College of Gastroenterology and the Canadian Association of Gastroenterology, dyspepsia is defined as the presence of predominant epigastric pain lasting for a minimum of one month. Any other UGI symptoms, such as epigastric fullness, nausea, vomiting, or heartburn, should accompany this pain.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Individuals with dyspepsia are more likely to be HP positive than asymptomatic individuals.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eDiagnosing HP infection can involve invasive techniques that require endoscopy and biopsy (such as histological examination, culture, and rapid urease tests), as well as noninvasive methods including serology, the urea breath test, and the detection of HP antigen in urine or stool samples.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e In numerous developing countries, access to facilities for UGI endoscopy (UGIE) is limited. Consequently, the diagnosis of UGI diseases relies primarily on clinical parameters in many cases. Incorrect or delayed diagnoses, leading to ineffective management, contribute to increased morbidity and economic losses for individuals.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Nevertheless, in numerous clinical situations, the gold standard approach is considered to be endoscopic biopsy followed by histological analysis.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe literature lacks information on the prevalence of HP infection in Nepal. Therefore, the main objective of this study was to ascertain the prevalence of HP infection among dyspeptic patients. In conjunction with these findings, this research aimed to investigate potential associations between Hp infection and various factors, including age and gender. Furthermore, this study aimed to explore the connections between Hp and both endoscopic and histopathological diagnoses.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and setting\u003c/h2\u003e\u003cp\u003eThis retrospective study was a two-center-based cross-sectional descriptive study conducted at the gastroenterology outpatient department of Gastro Center, Butwal, Pvt. Ltd., a specialized clinic in Butwal, Nepal, and the endoscopy unit of the Department of Gastroenterology at Tribhuvan University Teaching Hospital. The study population included all patients who attended the gastroenterology clinic between July 2024 and December 2024, for various dyspeptic symptoms and subsequently underwent UGIE.\u003c/p\u003e\u003cp\u003eEndoscopic evaluation was performed via an IMAGINA i10c endoscope (PENTAX MEDICAL), following standard procedures. Comprehensive endoscopic evaluations covered all anatomic regions of the esophagus, stomach, and the first and second parts of the duodenum. Mucosal biopsies were systematically obtained from the antrum, body of the stomach, and any suspicious lesions for histopathological examination. Specifically, two biopsies were taken from the antrum and one from the gastric body to facilitate accurate detection of HP. The histopathological diagnosis of HP infection in the biopsy sample was performed via Giemsa stain.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eCalculation of sample size\u003c/h3\u003e\n\u003cp\u003eBased on a study reported by Sardar et al., the prevalence of HP infection is 73.3%.\u003csup\u003e8\u003c/sup\u003e As the study was performed in an infinite population, the sample size (SS) was calculated as follows:\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:\\varvec{S}\\varvec{S}=\\frac{{\\varvec{Z}}^{2}\\left(\\varvec{P}\\right)\\left(1-\\varvec{P}\\right)}{{\\varvec{d}}^{2}}$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eZ\u0026thinsp;=\u0026thinsp;standard normal prevalence at 95% confidence interval (CI)\u0026thinsp;=\u0026thinsp;1.96\u003c/p\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;prevalence rate\u0026thinsp;=\u0026thinsp;73.3% = 0.733\u003c/p\u003e\u003cp\u003ed\u0026thinsp;=\u0026thinsp;precision\u0026thinsp;=\u0026thinsp;0.05\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003cimg 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CB8EGr/85P1Kg2BEKE6fPj2NuYZ5ydZsqKLhIMBEuWDerNATNHNWMQ+Wj82R5acNJ+izebrCiQNtrqwsOC42txfzcDGnlxDNQF3IErJ69eobNCMcwz700EPp1jXQopiq2U9rHqwPHDjgQvPXaFMzG2htaHVZMLNEbI6szz77zDmDFaIZSIC1gJjNKLYUATsUNiuEhj/HFk4uEGrm9MKwbp05vfj8889daI41DHOkkeUvMQvclG3cuDHdEqKxSIC1gIrmW2ipBnNq4ZQVZxkIjpiwyfNQ7VOPaWM4f6XrWdVBhhD1QgKsxGCIHxoaSnp7e52n6QceeKDQ18NGwceErq6udEuIxiMB1gJi3cXYUgQ0JwQZXx/pMppNqxVgc7v33nvTLSEajwRYC4h1F2NLLZhB3bqMDIegO5flLPaee+5xoRn+w+6nHWdu+KuBLQ7Dv7qPoplIgI0RbBDrokWLXAgItdBZrDmANWexpjH5jmFJH3MMm8dHH33kpmEWoqlU3vSiZOAvEX+FjAcDxmQxDiwcl8X4L388Fw5d2Q79LbJNPGO4zMci2/74MXM8G/PVaOfx0wvRDCTASgiCCoGBQCFEmJm36RCEEgNcScsAUwayxjAhRjryC529mvCLHU958ga9CtEo9CuREKK0yAYmhCgtEmBCiNIiASaEKC0SYEKI0iIBJoQoLRJgQojSIgEmhCgtEmBCiNIiASaEKC0SYEKI0iIBJoQoLRJgQojSIgEmhCgtEmBCiNIiASaEKC0SYEKI0iIBJoQoLRJgQojSIgEmhCgtEmBCiNIiAVYCcDq7cOFC56178uTJyc6dO9M9Izl37tz1dLNmzbrBWa1x6dKlZPv27ded4QpRViTA2hyE0t69e5OXXnop6e/vd45rt23b5tz4+5Bu3rx5SVdXl/Pq/corryTLli27QYghvC5cuJDs378/uXz5chorRDmRW7U2B0Hla0p4zZ46dWrS29ubbN26NY1NnMY1adKk5MyZM2nMNc/cZ8+eTQYGBtKY/1i1apULjxw54kIhyog0sDYn7OZduXLFhZ2dnS4EtK/BwcFk7dq1acw1VqxY4eKzupJClB0JsJKA5oU2tm7dumTfvn3J3Llz0z1JcvToURfOmTPHhcbs2bNdePLkSRcKMdaQACsJGzZsSNavX++6hHv27HG2rJAJEyaka0KMDyTAWgCaFF8T+VrIV8PNmze7OLqCgHAKvzRiq6I72N3d7TQuNDEhxjsSYC3g22+/TS5evOi+Fr711luuO3jo0KHk4YcfdkJt5cqVI2xcxowZM5Jdu3Y5IYYmZgJPiPGKBFgLQAhNmTLFrS9dujTZtGmT08D4WohQI/RtXCGPPvqoCzs6Olxowi60ddn2kiVLXCjEWEMCrIRcvXo1mTlzptPIAGHH9vHjx922wTbxCEkhxiISYG0OwyiwkVl3kSERTz75ZHLw4EG3bWDYxzaGJgd9fX1um/gQvmiynD592oVClBYGsor2paenh4HGbqloU8Pd3d3Dg4OD6d6R9Pf3uzSkXbBgwfCJEyfSPf9BnOVnS29vb7pXiHKhkfhCiNKiLqQQorRIgAkhSosEmBCitEiACSFKSpL8H8hk3Z2FFhVAAAAAAElFTkSuQmCC\"\u003e\u003c/p\u003e\u003cp\u003eAccording to the formula provided above, the study necessitates a minimum sample size of 301 participants. However, more patients were recruited to increase the power of the study.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEligibility criteria\u003c/h3\u003e\n\u003cp\u003ePatients eligible for inclusion were those who presented with undiagnosed dyspeptic symptoms and were aged 18 years and above. All patients had at least one symptom of dyspepsia, including belching, vomiting, postprandial fullness, early satiation, epigastric pain, or burning. Individuals with a preexisting diagnosis of HP, along with patients who had taken antibiotics and proton pump inhibitors (PPI) within two weeks before the endoscopic examination, were excluded from the study.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData collection and definitions\u003c/h2\u003e\u003cp\u003e The working definition of dyspepsia was based on the collaborative guidelines of the American College of Gastroenterology and the Canadian Association of Gastroenterology. Findings at endoscopy were recorded and categorized as esophagitis, hiatal hernia, esophageal stricture, gastritis, gastric erosions, gastric ulcer, gastric polyps, duodenitis, duodenal erosions, duodenal ulcer, duodenal stricture, biopsy-proven malignancy, and \u0026ldquo;others\u0026rdquo; for potential findings. A significant finding possibly related to dyspepsia was defined as esophagitis, gastritis, gastric or duodenal ulcers, or erosions, and suspected malignancy.\u003c/p\u003e\u003cp\u003eThe medical records of each patient were examined from the records of the endoscopy software and electronic histopathology reports, and relevant information about the objectives was extracted. The data collection included details about the patients' demographic profiles, including age, gender, and the diagnoses derived from both endoscopy and histopathological examinations.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eThe data were analyzed using the Statistical Package for Social Sciences \u0026minus;\u0026thinsp;26 (IBM, Armonk, NY, USA), The results are presented as the means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations for quantitative variables and frequencies (percentages) for qualitative variables. Categorical variables were compared with Pearson\u0026rsquo;s chi-square test. A significant P value was taken as \u0026lt;\u0026thinsp;0.05 at the 95% CI. Graphical illustrations were generated using Microsoft Excel, 2016.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEthical Consideration\u003c/h3\u003e\n\u003cp\u003e The study received ethical approval from the Institutional Review Committee. This study conformed to the provisions of the Declaration of Helsinki.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 555 patients were enrolled in the study. The mean age was 45.7\u0026thinsp;\u0026plusmn;\u0026thinsp;15.2 years. Females comprised the majority of participants, accounting for 323 cases (58.2%), and 232 (41.8%) were male (M: F \u0026ndash; 1:1.4).\u003c/p\u003e\u003cp\u003eGastritis was the most frequently observed endoscopic finding, and was present in 516 patients (93.0%), followed by hiatus hernia in 365 (65.8%) and esophagitis in 327 (58.9%). Ulcers were seen in 220 patients (39.6%), whereas duodenitis and erosions were noted in 155 (27.9%) and 72 (13.0%) patients, respectively. These results indicate a predominance of upper gastrointestinal inflammation and structural abnormalities in the study population (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAmong the 555 dyspeptic patients, 327 (59.0%) had erosive esophagitis, with the majority presenting with mild grades (Los Angeles; LA-A and LA-B;). Only a few cases of severe esophagitis were noted, including one patient with LA-C and three with LA-D. Normal esophageal findings were observed in 210 patients (37.8%). Hiatus hernias were present in 365 patients (65.8%), accounting for nearly two-thirds of the cohort. Suspected Barrett\u0026rsquo;s esophagus and candidiasis were identified in seven patients each. Among the three patients with suspected esophageal malignancies, two were confirmed to have esophageal squamous cell carcinoma on biopsy. Additionally, one case each of an esophageal stricture and esophageal web was recorded (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePangastritis emerged as the most prevalent gastric abnormality, identified in 287 patients (51.7%), followed by antral gastritis in 214 patients (38.6%). Gastric ulcers were documented in nearly one-third of the patients (n\u0026thinsp;=\u0026thinsp;192, 34.5%), reflecting a considerable burden of mucosal injury. Gastric erosions and enterogastric reflux gastritis were observed in 26 and 15 patients, respectively. A macroscopically normal gastric mucosa was noted in only 10 individuals. Notably, three patients were endoscopically suspected of harboring a gastric malignancy, with histopathological confirmation of carcinoma in one patient (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDuodenal endoscopy was unremarkable in nearly half of the patients (n\u0026thinsp;=\u0026thinsp;269, 48.5%). Duodenitis was identified in 155 individuals (27.9%), representing the most common abnormality, followed by duodenal ulcers, which were observed in 60 patients (10.8%). These findings highlight the modest prevalence of duodenal pathology among the dyspeptic cohort (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eEndoscopic findings observed in the esophagus, stomach, and duodenum among individuals presenting with dyspepsia\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFindings\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency (N\u0026thinsp;=\u0026thinsp;555)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eEsophagus\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEsophagitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e327\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHiatus Hernia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e365\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBarrett's\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCandidiasis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSuspected Malignancy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStricture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeb\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eStomach\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePangastritis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e287\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntral Gastritis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e214\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUlcer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eErosions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnterogastric Reflux Gastritis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePolyp\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSuspected Malignancy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDuodenum\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e269\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuodenitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e155\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUlcer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eErosions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStricture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e* The sum of these individual findings in the table is greater than this cumulative value because some patients had more than one particular finding.\u003c/p\u003e\u003cp\u003eThe study revealed a statistically significant relationship between gender and peptic ulcer type (p\u0026thinsp;=\u0026thinsp;0.040). Females more often presented with gastric ulcers, whereas duodenal and combined gastric-duodenal ulcers predominated among males, suggesting gender-specific variations in ulcer localization (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). However, the distribution of ulcer types did not differ significantly across age groups (p\u0026thinsp;=\u0026thinsp;0.695).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRelationships of ulcer with gender\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eUlcer based on location\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGastric ulcer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDuodenal ulcer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eGastric and duodenal ulcers\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e207 (61.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e90 (56.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13 (46.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13 (39.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e128 (38.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69 (43.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15 (53.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20 (60.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe total prevalence of HP among dyspeptic patients who underwent UGIE was 16.8% (n\u0026thinsp;=\u0026thinsp;93) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). A chi-square test showed no statistically significant associations between HP infection status and gender (p\u0026thinsp;=\u0026thinsp;0.666), indicating that infection rates did not differ meaningfully between males (15.9%) and females (17.3%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe highest proportion of HP positivity was observed in the 25\u0026ndash;34 age group (26.4%), followed by the 35\u0026ndash;44 age group (16.9%). In contrast, individuals aged above 55 years had the lowest infection rate, with only 9.9% testing positive (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e4\u003c/span\u003e). These findings suggest that HP infection is more prevalent among younger adults in this sample. The chi-square test revealed a statistically significant association between age group and HP infection status (p\u0026thinsp;=\u0026thinsp;0.008).\u003c/p\u003e\u003cp\u003eA statistically significant association was not detected between HP status and any of the listed endoscopic findings, including antral gastritis (p\u0026thinsp;=\u0026thinsp;0.504), pangastritis (p\u0026thinsp;=\u0026thinsp;0.983), duodenitis (p\u0026thinsp;=\u0026thinsp;0.608), and ulcers (p\u0026thinsp;=\u0026thinsp;0.233). Although a slightly greater percentage of ulcers and pangastritis were observed in HP-positive individuals than in HP-negative individuals, these differences were not statistically significant (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). These findings suggest that while these conditions may coexist with HP infection, their presence alone does not reliably predict infection status based on endoscopic findings.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation between H. pylori infection and common endoscopic findings among patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e\u003cp\u003eEndoscopic findings\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e\u003cem\u003eH. pylori\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eP- value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003ePositive\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eNegative\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003en\u0026thinsp;=\u0026thinsp;93 (% within column)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003en\u0026thinsp;=\u0026thinsp;462 (% within column)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAntral\u003c/p\u003e\u003cp\u003eGastritis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePresent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33 (35.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e181 (39.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.504\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60 (64.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e281 (60.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePangastritis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePresent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48 (51.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e239 (51.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.983\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45 (48.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e223 (48.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDuodenitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePresent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28 (30.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e127 (27.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.608\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65 (69.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e335 (72.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eUlcer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePresent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42 (45.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e178 (38.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.233\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51 (54.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e284 (61.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThere was a strong and statistically significant association between HP infection and the presence of active chronic gastritis, inactive chronic gastritis, and atrophy (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01 for all). Nearly 98% of HP-positive patients had active chronic gastritis, whereas only 40.3% of HP-negative individuals had active chronic gastritis. In contrast, inactive chronic gastritis was primarily observed in HP-negative patients (53.0%). Similarly, gastric atrophy was more common among those infected with HP (55.9% vs. 22.7%). However, the presence of intestinal metaplasia was not significantly associated with HP status (p\u0026thinsp;=\u0026thinsp;0.721), suggesting that metaplasia may occur independently of active infection (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation between H. pylori infection and histopathological findings among patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e\u003cp\u003eHistopathologic findings\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e\u003cem\u003eH. pylori\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eP- value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003ePositive\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eNegative\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003en\u0026thinsp;=\u0026thinsp;93 (% within column)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003en\u0026thinsp;=\u0026thinsp;462 (% within column)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eActive Chronic Gastritis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePresent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91 (97.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e186 (40.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (2.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e276 (59.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eInactive Chronic Gastritis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePresent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (2.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e245 (53.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91 (97.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e217 (47.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAtrophy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePresent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52 (55.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e105 (22.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41 (41.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e357 (77.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMetaplasia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePresent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (7.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e40 (8.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.721\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86 (92.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e422 (91.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this study, the ages of patients who presented with dyspepsia ranged from 18 to 87 years, with a mean age of 45.7 years. Among 555 patients enrolled, 323 (58.2%) were female, and 232 (41.8%) were male, yielding a male-to-female ratio of 1:1.4. Similar demographic patterns have been reported by K.C. et al. and Sharma et al., both of whom reported a mean patient age in their 40s and a female predominance, which is consistent with the findings of the present study.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Hence, dyspeptic symptoms were more prevalent in female patients.\u003c/p\u003e\u003cp\u003eOrganic causes of dyspepsia were identified in the majority of our cases, aligning with findings from a study conducted in India, where 87% of patients were reported to have organic etiologies of dyspepsia.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e In our study, the most common endoscopic findings among dyspeptic patients were gastritis (92.9%), followed by hiatus hernia (65.8%), esophagitis (59.0%), ulcers (39.6%), duodenitis (27.9%), and erosions (12.9%). Similarly, Shrestha et al. reported gastritis as the predominant finding, which was observed in 60.2% of dyspeptic patients, followed by duodenitis in 4.4% of cases.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e In contrast, K.C. et al. and Subedi et al. reported ulcers as the predominant endoscopic finding, followed by gastritis.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eHP represents the most widespread bacterial infection globally, and is estimated to affect approximately 4.4\u0026nbsp;billion individuals\u0026mdash;more than half of the world\u0026rsquo;s population. Its prevalence shows marked geographic variation, ranging from 30\u0026ndash;50% in developed nations to as high as 85\u0026ndash;95% in developing countries.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e In the present study, the prevalence of HP infection among patients with dyspepsia was 16.7%. Comparable rates have been reported in previous studies, including 20.0% in Nepal by Chaudhary et al. and 16.4% in Japan among dyspeptic individuals.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e The prevalence observed in our study was notably lower than that reported in similar studies conducted in various regions of Nepal, where the reported prevalence rates ranged from 32.9\u0026ndash;68.1%.\u003csup\u003e12, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e A substantially higher prevalence rate of 85.0% was reported in the neighboring country, India, in a study conducted by Agarwal et al.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e A comprehensive systematic review and meta-analysis encompassing 184 studies across 62 countries reported the highest pooled prevalence of HP infection in Africa (70.1%) and the lowest in Oceania (24.4%). Southern Asia presented a prevalence of approximately 61.6%. Among individual countries, Nigeria reported the highest prevalence at 87.7%, whereas Switzerland had the lowest at 18.9%.\u003csup\u003e19\u003c/sup\u003e The disparity in prevalence observed in our study compared with previous reports may result from differing diagnostic methods, patient populations, hygiene standards, urban development, and socioeconomic status.\u003c/p\u003e\u003cp\u003eIn the present study, the prevalence of HP infection among female dyspeptic patients (17.3%) was slightly higher than that observed in male patients (15.9%), which contrasts with the findings reported by K.C. et al., where a higher prevalence was noted among males.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e However, no statistically significant difference in HP prevalence was observed between genders, which is consistent with the findings reported by Agarwal et al.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e The age distribution of HP infection in our study revealed a greater proportion of positive individuals aged 25\u0026ndash;34 years (26.4%) and 35\u0026ndash;44 years (16.9%), similar to the observations of Kaore et al., who reported a greater prevalence of infection in the 20\u0026ndash;40-year age group than in older age groups.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe endoscopic findings in the present study, including antral gastritis, pangastritis, duodenitis, and ulcers, were not significantly associated with HP infection, which contrasts with the findings reported from central and eastern Nepal, where significant associations were observed.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e This finding aligns with the understanding that endoscopic abnormalities are often multifactorial in origin and may not be specifically indicative of HP infection. Although procedural precautions\u0026mdash;such as obtaining biopsies from multiple gastric sites and withholding PPIs before endoscopy\u0026mdash;were implemented to optimize detection, factors including the presence of atrophic gastritis and intestinal metaplasia may have contributed to false-negative results.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe most common histopathological finding was active chronic gastritis, accounting for 49.9% of cases, followed by inactive chronic gastritis at 44.5%, in concordance with a study conducted by K.C. et al.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e There was a strong, significant association between Hp infection and histopathological findings in our study, with active chronic gastritis (97.8%) and atrophy (55.9%) being more common in infected individuals, whereas inactive chronic gastritis predominated in those without infection (53.0%). In our study, atrophy and intestinal metaplasia were observed in 28.3% (157/555) and 8.5% (47/555) of dyspeptic patients, respectively\u0026mdash;substantially higher than the 2.4% (24/1020) and 3.0% (31/1024) reported in another study.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThis research has several significant strengths that increase its value and relevance. This study involved a large cohort of 555 dyspeptic patients from two healthcare institutions, enhancing the diversity and generalizability of the findings. Comprehensive endoscopic and histopathological assessments across the esophagus, stomach, and duodenum provided a broad view of upper gastrointestinal pathology. Histologic evaluation of gastric biopsies allows for meaningful correlation with HP status, and the identification of clinically significant conditions such as atrophy, metaplasia, and suspected malignancy adds to its practical relevance.\u003c/p\u003e\u003cp\u003eNevertheless, certain limitations must be acknowledged. The cross-sectional design limits the ability to establish causal relationships between HP infection and observed abnormalities. Functional dyspepsia was not assessed, and confounding factors such as nonsteroidal analgesic use, smoking, alcohol intake, or socioeconomic background were not considered, which may influence both the clinical and pathological findings. Despite these limitations, this study provides valuable and detailed insights into the organic causes of dyspepsia in a clinical setting.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThis study highlights the substantial burden of endoscopic and histopathological abnormalities among individuals presenting with dyspepsia. While HP infection was not significantly associated with common endoscopic findings such as antral gastritis, pangastritis, duodenitis, or peptic ulcers, a strong and statistically significant association was observed between HP and histological features, particularly active chronic gastritis and gastric atrophy (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Gender-based differences in ulcer type were also noted, with females being more likely to present with gastric ulcers and males presenting with duodenal or mixed ulcers. These findings underscore the importance of combining histologic assessment with endoscopic evaluation for accurate diagnosis and targeted management of dyspeptic patients.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eCI:\u0026nbsp;\u003c/strong\u003eConfidence interval\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHP:\u0026nbsp;\u003c/strong\u003e\u003cem\u003eHelicobacter pylori\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLA:\u0026nbsp;\u003c/strong\u003eLos Angeles\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePPI\u003c/strong\u003e: Proton pump inhibitors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUGI\u003c/strong\u003e: Upper gastrointestinal\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUGIE\u003c/strong\u003e: Upper gastrointestinal endoscopy\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Institutional Review Committee (IRC) of Tribhuvan University (TU), Institute of Medicine (IOM) [Reference proposal number:\u0026nbsp;081/082 - 495]. Due to the retrospective study design, written informed consent was waived by IRC, TU, IOM. This study adhered to the Declaration of Helsinki and complied with the Declaration regarding human data and material.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s Contribution:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAR: Conceptualization, Methodology, Software, Data curation, Investigation, Validation, Formal analysis, Visualization, Project administration, Resources, Writing - original draft, Writing - review \u0026amp; editing;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMB: Conceptualization, Methodology, Supervision, Visualization Resources, Writing - original draft, Writing - review \u0026amp; editing;\u003c/p\u003e\n\u003cp\u003eSP, SR: Software, Data curation, Writing - original draft, Writing\u0026mdash;review \u0026amp; editing;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRP, PK: Conceptualization, Validation, Formal analysis, Writing - review \u0026amp; editing\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo acknowledgement to be made.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBauer B, Meyer TF. The Human Gastric PathogenHelicobacter pyloriand Its Association with Gastric Cancer and Ulcer Disease. Ulcers. 2011;2011:1-23.\u003c/li\u003e\n\u003cli\u003eGravina AG, Priadko K, Ciamarra P, Granata L, Facchiano A, Miranda A, et al. Extra-Gastric Manifestations of Helicobacter pylori Infection. J Clin Med. 2020;9(12).\u003c/li\u003e\n\u003cli\u003eMoayyedi P, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N. ACG and CAG Clinical Guideline: Management of Dyspepsia. Am J Gastroenterol. 2017;112(7):988-1013.\u003c/li\u003e\n\u003cli\u003eSuvak B, Dulger AC, Suvak O, Aytemiz E, Kemik O. The prevalence of helicobacter pylori among dyspeptic patients in an earthquake-stricken area. Clinics (Sao Paulo). 2015;70(1):69-72.\u003c/li\u003e\n\u003cli\u003eRicci C, Holton J, Vaira D. Diagnosis of Helicobacter pylori: Invasive and non-invasive tests. Best Practice \u0026amp; Research Clinical Gastroenterology. 2007;21(2):299-313.\u003c/li\u003e\n\u003cli\u003eAgbakwuru EA, Fatusi AO, Ndububa DA, Alatise OI, Arigbabu OA, Akinola DO. Pattern and validity of clinical diagnosis of upper gastrointestinal diseases in south-west Nigeria. Afr Health Sci. 2006;6(2):98-103.\u003c/li\u003e\n\u003cli\u003eTalebi Bezmin Abadi A. Diagnosis of Helicobacter pylori Using Invasive and Noninvasive Approaches. J Pathog. 2018;2018:9064952.\u003c/li\u003e\n\u003cli\u003eSardar M, Kumar D, Aakash F, Partab F, Kumar S, Barkha F, et al. Prevalence and etiology of Helicobacter pylori infection in dyspepsia patients: a hospital-based cross-sectional study. Ann Med Surg (Lond). 2023;85(4):665-9.\u003c/li\u003e\n\u003cli\u003eAmatya GL, Koirala K, Lakhey A, K.C SR. Prevalence of Helicobacter pylori among patients with dyspepsia and correlation between endoscopic and histological diagnosis. Journal of Pathology of Nepal. 2016;6(11):942-6.\u003c/li\u003e\n\u003cli\u003eSharma SK, Maharjan DK, Thapa PB. Hospital based analytic study of peptic ulcer disease in patients with dyspeptic symptoms. Kathmandu Univ Med J (KUMJ). 2009;7(26):135-8.\u003c/li\u003e\n\u003cli\u003eAgarwal PK, Badkur M, Agarwal R, Patel S. Prevalence of Helicobacter pylori infection in upper gastrointestinal tract disorders (dyspepsia) patients visiting outpatient department of a hospital of North India. J Family Med Prim Care. 2018;7(3):577-80.\u003c/li\u003e\n\u003cli\u003eDas RN, Deo A, Chhetri G, Shrestha R. A descriptive cross-sectional study of helicobacter pylori infection in non-ulcer dyspepsia patients in a tertiary care teaching hospital In the Eastern part of Nepal. Journal of Nobel Medical College. 2016;5(2):10-6.\u003c/li\u003e\n\u003cli\u003eSubedi RC, Regmi BU, Pathak BD, Dhakal B, Sitaula D, Paudel U, et al. Prevalence of Helicobacter pylori infection in dyspeptic patients presenting to a tertiary care center of a developing country: a cross-sectional study. F1000Research. 2023;12.\u003c/li\u003e\n\u003cli\u003eBashir SK, Khan MB, Wu J. Overview of Helicobacter pylori Infection, Prevalence, Risk Factors, and Its Prevention. Advanced Gut \u0026amp; Microbiome Research. 2023;2023:1-9.\u003c/li\u003e\n\u003cli\u003eChaudhary NK, Paudel S. Helicobacter Pylori Infection among Dyspeptic Patients in Chitwan, Nepal. Journal of Chitwan Medical College. 2022;11(4):69-72.\u003c/li\u003e\n\u003cli\u003eShimatani T, Inoue M, Iwamoto K, Hyogo H, Yokozaki M, Saeki T, et al. Prevalence of Helicobacter pylori infection, endoscopic gastric findings and dyspeptic symptoms among a young Japanese population born in the 1970s. J Gastroenterol Hepatol. 2005;20(9):1352-7.\u003c/li\u003e\n\u003cli\u003eShrestha S, Paudel P, Pradhan GB, Shrestha L, Bhattachan CL. Prevalence study of H. pylori infection in dyspeptic patients coming to Nepal Medical College Teaching Hospital, Jorpati, Kathmandu. Nepal Med Coll J. 2012;14(3):229-33.\u003c/li\u003e\n\u003cli\u003eTimilsina S, Sharma Acharya B, Shrestha B. Prevalence of Helicobacter Pylori Infection in Endoscopic Biopsy Specimen among Acid Peptic Disorder Patients Attending Gastro-Outpatient Department of a Tertiary Care Center in Central Nepal. Journal of Chitwan Medical College. 2023;13(2):86-8.\u003c/li\u003e\n\u003cli\u003eHooi JKY, Lai WY, Ng WK, Suen MMY, Underwood FE, Tanyingoh D, et al. Global Prevalence of Helicobacter pylori Infection: Systematic Review and Meta-Analysis. Gastroenterology. 2017;153(2):420-9.\u003c/li\u003e\n\u003cli\u003eKaore NM, Nagdeo NV, Thombare V. Comparative evaluation of the diagnostic tests for Helicobacter pylori and dietary influence for its acquisition in dyspeptic patients: A rural hospital based study in central India. JCDR. 2012;6:636-41.\u003c/li\u003e\n\u003cli\u003eLee JY, Kim N. Diagnosis of Helicobacter pylori by invasive test: histology. Ann Transl Med. 2015;3(1):10.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Atrophic gastritis, cross-sectional study, dyspepsia, endoscopy, histopathology, Helicobacter pylori, gastritis, intestinal metaplasia","lastPublishedDoi":"10.21203/rs.3.rs-7311683/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7311683/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eDyspepsia is a prevalent gastrointestinal issue with a variety of underlying causes, which can range from functional disorders to significant organic diseases. The objective of this study was to identify the underlying causes of dyspepsia by evaluating the prevalence of \u003cem\u003eHelicobacter pylori\u003c/em\u003e infection and examining associated endoscopic and histopathological findings in affected patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional study involving 555 adult patients who presented with dyspepsia at two healthcare facilities in Nepal was carried out. All participants underwent upper gastrointestinal endoscopy, during which targeted biopsies were collected from the esophagus, stomach, and duodenum depending upon the endoscopic findings. Histological analysis via Giemsa stain was conducted to detect \u003cem\u003eH. pylori.\u003c/em\u003e The relationships between \u003cem\u003eH. pylori\u003c/em\u003e status and various clinical, endoscopic, and histopathological findings were assessed via chi-square tests.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe average age of the participants was 45.7\u0026thinsp;\u0026plusmn;\u0026thinsp;15.2 years, with a predominance of females (58.2%). The most common endoscopic finding was gastritis (93.0%), followed by hiatus hernia (65.8%), esophagitis (59.0%), ulcers (39.6%), duodenitis (27.9%), and erosions (13.0%). \u003cem\u003eH. pylori\u003c/em\u003e infection was identified in 16.8% of the patients. The type of peptic ulcer differed significantly by sex (p\u0026thinsp;=\u0026thinsp;0.040), with gastric ulcers occurring frequently in females and duodenal or mixed ulcers occurring more frequently in males. A statistically significant correlation was found between \u003cem\u003eH. pylori\u003c/em\u003e infection and histopathologic characteristics, including active chronic gastritis (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), inactive chronic gastritis (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and atrophy (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). However, no significant association was observed between \u003cem\u003eH. pylori\u003c/em\u003e and endoscopic findings such as gastritis, duodenitis, or ulceration (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eOrganic abnormalities are frequently noted among patients with dyspepsia, with gastritis being the most prominent endoscopic feature. Although \u003cem\u003eH. pylori\u003c/em\u003e infection strongly correlated with histologic indicators of chronic gastritis and atrophy, its association with endoscopic findings is limited. These findings underscore the importance of histopathological evaluation in the thorough assessment of dyspepsia.\u003c/p\u003e","manuscriptTitle":"Endoscopic findings and prevalence of Helicobacter pylori among dyspeptic patients in Nepal: A cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-27 07:50:08","doi":"10.21203/rs.3.rs-7311683/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dce9e313-7166-428f-b2e8-4856c74d47aa","owner":[],"postedDate":"August 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-16T03:55:35+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-27 07:50:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7311683","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7311683","identity":"rs-7311683","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}