Correlation of Endoscopic Findings with Symptoms in Dyspepsia: A Prospective Cross-Sectional Study from a Tertiary Care Hospital in Karachi, Pakistan

Abstract

Background and Objective: Dyspepsia is a common gastrointestinal condition, which shows a large variation in prevalence among different regions of the world depending on diet, Helicobacter pylori prevalence and socio-economic factors, affecting 20–40% of adults worldwide. It is generally acknowledged that there is poor correlation between the endoscopic findings and the severity of symptoms and opinions are divided on the use of upper gastrointestinal endoscopy. The aim of this study was to determine the spectrum of endoscopic findings, to look for correlation with clinical symptoms and to understand the influence on endoscopic findings of diet, demographic and H. pylori status in a tertiary care setting in Karachi, Pakistan. Methods: This was a prospective cross sectional observational study at the Baqai Medical University Hospital from January 2025 until June 2025. A total of three hundred consecutive patients age 18–70 years with uninvestigated dyspepsia were enrolled. Symptoms were measured on a validated Gastrointestinal Symptom Questionnaire, and expressed in terms of frequency and severity (4-point Likert scale). Endoscopy of the upper gastrointestinal tract and systematic biopsies were carried out. Results were analysed according to the Kyoto classification of gastritis. SPSS version 27 software was used for data analysis, which included Spearman's correlation, Chi-square tests and multivariate regression. Results: Mean age was 45.2 ± 12.8 years; 50.3% were female. The most common endoscopic diagnoses were normal mucosa (functional dyspepsia) (48.7%), gastritis (28.3%) and peptic ulcer disease (12.7%). Sixty-two percent of the cases of gastritis were H. pylori positive. Modest correlations existed between epigastric pain and peptic ulcer (r = 0.312, p < 0.01) and heartburn with erosive esophagitis (r = 0.285, p < 0.01). There was weak association for bloating and early satiety. There was a strong correlation between spicy and high-fat diets and severity of symptoms. Conclusion: This study reveals that most of the patients had normal endoscopic mucosa, while gastritis and peptic ulcer disease were the major pathological findings. H.pylori infection is strongly associated with peptic ulcers (76.3%) and gastritis (62.3%), indicating its significant role in these upper GI pathologies. Targeted H.pylori eradication may reduce gastritis and ulcer prevalence in this population. Results recommend selective endoscopy conducted by risk stratification and H. pylori testing to save resources.

Keywords: Dyspepsia, upper gastrointestinal endoscopy, gastritis, peptic ulcer disease, Helicobacter pylori, functional dyspepsia, Kyoto classification, symptom correlation