Background: Helicobacter pylori ( H. pylori ) infection remains highly prevalent in low- and middle-income countries and is a major cause of chronic gastritis and upper gastrointestinal morbidity. In endemic settings, infection was often influenced by environmental and hygienic exposures. Data examining these associations among symptomatic gastritis patients in Pakistan are limited. Objective: To describe the prevalence of H. pylori positivity and examine its association with environmental, hygienic, and lifestyle characteristics among patients with clinically diagnosed gastritis in Northern Pakistan. Methods: This multi-center cross-sectional study was conducted from January to December 2024 in 3 tertiary-care hospitals in Islamabad, Rawalpindi, and Wah Cantt. Patients aged ⩾16 years with clinically diagnosed gastritis were consecutively enrolled. H. pylori status was determined using invasive and non-invasive diagnostic modalities employed in routine clinical care. Sociodemographic, environmental and behavioural data were collected using a structured, pilot-tested questionnaire. Associations were assessed using chi-square or Fisher’s exact tests. Results: Among 250 participants, 225 (90.0%) were H. pylori positive. Infection status was not significantly associated with age, sex, education level or place of residence. In contrast, untreated drinking water, absence of household water treatment, poor hand hygiene, skipping or delaying meals and consumption of uncooked or undercooked food were significantly associated with H. pylori positivity ( p ⩽ 0.001). There were substantial overlaps in gastrointestinal symptoms between infected and non-infected patients. In H. pylo r i -positive people, post-treatment eradication was noted in 65.6% and recurrence in 40.0%. Conclusion: In this endemic area, the prevalence of H. pylori positivity became very high among individuals who surpassed the clinical diagnosis of gastritis. Infection status was strongly associated with environmental and hygienic factors in this symptomatic population. These results reflect associations and not causal determinants and emphasize the need of longitudinal studies.
Shahid et al. (Sun,) studied this question.