Risk factors and comparative diagnostic performance of Helicobacter pylori infection among endoscopy-confirmed peptic ulcer patients at teaching hospital in the Sukkur region, Pakistan

Objective: To determine the burden of Helicobacter pylori infection among endoscopy-confirmed peptic ulcer disease (PUD) patients, identify associated risk factors, and compare the diagnostic yield of commonly used non-invasive and biopsy-based tests in a tertiary-care setting of upper Sindh. Methodology: This cross-sectional analytical study was conducted at Civil Hospital, Ghulam Muhammad Mahar Medical College (GMMC), Sukkur, Pakistan, from January, 2025 to December, 2025. Adults aged 18–80 years with endoscopically confirmed PUD were enrolled. Paired blood and stool samples were obtained from 325 participants for serology (IgM/IgG immuno-chromatographic test) and stool antigen immunoassay. A biopsy subset (n=100) additionally underwent a rapid urease test (RUT) for and histopathology. Associations with H. pylori positivity were evaluated using logistic regression and reported as odds ratios (OR) with 95% confidence intervals (CI). Results: Serology was positive in 73.84% (240/325) and stool antigen in 70.15% (228/325). In the biopsy subset, RUT was positive in 50.0% (50/100), while histopathology detected H. pylori in 43.0% (43/100). Low socioeconomic status, unsafe drinking water, and current smoking were independently associated with positivity on at least one non-invasive test. Conclusion: H. pylori infection remains highly prevalent among peptic ulcer patients in Upper Sindh, and detection varies by test type and specimen. Using non-invasive tests routinely, with adjunct biopsy-based testing when endoscopy is performed, may improve diagnostic yield and facilitate timely management.