Vol. 7, Issue 1, Part A (2025)

Background: Upper gastrointestinal (GI) diseases pose a significant clinical challenge in India, with patterns shaped by infection, lifestyle, and evolving treatment practices. Despite their prevalence, comprehensive multicentre data on endoscopic findings and management are scarce.

Aim: To characterize the spectrum of upper GI endoscopic diagnoses, demographic correlations, and therapeutic strategies in symptomatic Indian patients undergoing upper GI endoscopy.

Methods: This retrospective observational study analyzed demographic, clinical, and endoscopic data from 1,701 patients across 171 centres in India between April 2024 and March 2025. Information on demographics, lifestyle factors, presenting symptoms, Helicobacter pylori status, endoscopic findings, and acid-suppressive therapy prescriptions was collected and analyzed. Descriptive statistics and multivariable logistic regression identified predictors of endoscopic abnormalities.

Results: Dyspeptic (49%) and reflux symptoms (31%) were most common. Non-erosive gastritis (33.9%), erosive gastritis (25.6%), and reflux esophagitis (17.3%) predominated. 48% of the patients who were tested had H. pylori infection, reflecting a gradual decline in prevalence compared to earlier Indian studies. Despite this, H.pylori infection remained a strong predictor of gastritis, ulcer disease, and gastroduodenitis. Male sex elevated the odds of esophageal varices and erosive gastroduodenitis. The antrum was the main site affected in gastritis (73.8%). The most common type of reflux oesophagitis was mild to moderate (LA Grades A and B). Vonoprazan-based therapy was the most prescribed (32.3%), followed by rabeprazole (21.3%). Age, H.pylori status, alcohol intake, and geographic zone were significant predictors of findings.

Conclusion: The endoscopic yield for symptomatic Indian patients is notably high, largely dominated by gastritis and reflux esophagitis. The widespread use of vonoprazan signals its emerging role as a preferred acid-suppressive therapy. These findings highlight the need for ongoing surveillance, improved diagnostics, and personalized, evidence-based management to reduce disease burden and improve patient outcomes nationwide.