Gastric disorders remain a major cause of morbidity worldwide, presenting a significant burden on healthcare systems. Symptoms such as dyspepsia, upper abdominal pain, and unexplained weight loss are notoriously vague. Relying solely on clinical symptoms to differentiate between a simple case of gastritis, a benign peptic ulcer, or early gastric cancer is often impossible. Upper gastrointestinal (UGI) endoscopy has revolutionized gastroenterology by allowing direct visualization of the mucosal lining, enabling targeted biopsies, and facilitating therapeutic interventions. In the specific demographic context of Koraput, Odisha—a region with a large rural and tribal population—patients frequently rely on traditional remedies and present to tertiary care centers like Saheed Laxman Nayak Medical College and Hospital (SLN MCH) only when symptoms become severe or refractory. This study was undertaken to evaluate the importance of UGI endoscopy in diagnosing gastric lesions among symptomatic patients at SLN MCH, aiming to establish a localized clinical profile and correlate endoscopic suspicions with histopathological realities.

Study Design and Setting: This was a hospital-based, cross-sectional observational study conducted in the Department of General Surgery / Medicine at SLN MCH, Koraput, Odisha. Study Period: The study spanned exactly one year, from February 2025 to January 2026. Sample Size: The study included 102 consecutive patients who were referred for UGI endoscopy. Inclusion and Exclusion Criteria: We included adult patients (aged 18 and above) presenting with persistent upper GI symptoms (dyspepsia, epigastric pain, nausea, vomiting, or suspected upper GI bleed). Patients who were medically unstable, pregnant, or refused consent were excluded. Study Parameters: To keep the study focused and clinically relevant, we avoided complicated parameters. We recorded basic demographic data (age, gender), primary presenting symptoms, visual endoscopic findings, and subsequent histopathological diagnoses. Statistical Analysis: Data were tabulated in Microsoft Excel and analyzed. Categorical variables were expressed as percentages. The Chi-square test was used to determine the statistical significance of associations between variables, with a p-value of < 0.05 considered significant.

Over the one-year study period, 102 patients underwent UGI endoscopy. The data reveals clear patterns in demographics, symptomatology, and pathology. The study cohort showed a clear male predominance (60.8%). The highest burden of gastric lesions was observed in middle-aged adults, specifically the 41–60 years bracket, which accounted for nearly half of the cases. Table 1: Age and Gender Distribution Age Group (Years) Male (n = 62) Female (n = 40) Total (N = 102) Percentage (%) 18–30 10 8 18 17.6% 31–40 14 12 26 25.5% 41–60 28 16 44 43.1% > 60 10 4 14 13.8% Fig 1: Primary Presenting Symptoms Patients often presented with overlapping symptoms, but we categorized them by their primary or most severe complaint. Epigastric pain was the clear leading symptom, prompting the majority of clinical referrals for endoscopy. During the visual inspection, 83.3% of the patients exhibited abnormal gastric mucosa. Simple erythematous or erosive gastritis was the most common visual finding, followed by gastric ulcers. Table 2: Endoscopic Findings Endoscopic Finding Number of Patients (n) Percentage (%) Gastritis (Erosive/Erythematous) 46 45.1% Gastric Ulcer 22 21.6% Normal Study 17 16.7% Suspected Malignant Growth 10 9.8% Gastric Polyps 7 6.8% Out of the 102 patients, biopsies were taken from 85 patients who showed mucosal abnormalities (gastritis, ulcers, growths, or polyps). The histopathology reports highlighted a high prevalence of H. pylori-associated chronic active gastritis. Table 3: Histopathological Diagnosis (Biopsied Cases) Histopathological Diagnosis Number of Cases (n = 85) Percentage (%) Chronic Active Gastritis (H. pylori +) 42 49.4% Chronic Gastritis (H. pylori -) 14 16.5% Benign Gastric Ulcer 17 20.0% Gastric Adenocarcinoma 9 10.6% Adenomatous Polyp 3 3.5% A critical parameter of our study was assessing how accurately visual endoscopy could predict malignancy. Out of 10 cases suspected to be malignant on visual inspection, 8 were confirmed as adenocarcinoma by pathology. Interestingly, 1 case visually diagnosed as a benign ulcer turned out to be malignant. Table 4: Correlation Between Endoscopic Suspicion and Histology for Malignancy Endoscopic Diagnosis Confirmed Benign on Biopsy Confirmed Malignant on Biopsy Total Suspected Malignant Growth 2 8 10 Suspected Benign Ulcer 21 1 22 Total 23 9 32 Statistical Significance: A Chi-square test was applied to this data. The association between a visual endoscopic diagnosis of a malignant growth and histological confirmation of adenocarcinoma was highly statistically significant (p < 0.01). Furthermore, the presence of H. pylori was significantly higher in patients with ulcerative lesions compared to those with normal or purely polypoid findings (p = 0.003).

Our study at SLN MCH Koraput underscores the vital diagnostic role of UGI endoscopy. The demographic spread in Table 1 aligns with national trends showing a male predominance in gastric lesions, likely linked to higher rates of tobacco and alcohol consumption, which are common local habits [1, 2]. The fact that 83.3% of our symptomatic patients had visually identifiable mucosal abnormalities (Table 3) strongly justifies the use of early endoscopy for persistent epigastric pain and dyspepsia. Gastritis was our most common finding (45.1%), mirroring studies by Agrawal et al. and Sharma et al. in other parts of India [4, 7]. Most importantly, our data in Table 5 proves why endoscopy combined with biopsy is non-negotiable. While the endoscopist's visual suspicion of malignancy was highly accurate (statistically significant at p < 0.01), one visually "benign" ulcer was proven malignant on biopsy. This reinforces the established clinical guideline that all gastric ulcers must be biopsied to rule out disguised malignancies [9, 12]. The high rate of H. pylori positivity (49.4% of biopsied cases) highlights an area for targeted public health intervention regarding sanitation and water safety in the Koraput district [14].

UGI endoscopy is an indispensable, safe, and highly accurate modality for evaluating gastric lesions. In a demographic like Koraput, where patients frequently present late in the disease process, endoscopy not only prevents the misdiagnosis of vague symptoms like dyspepsia but serves as a critical, life-saving tool for the early detection of gastric malignancies. The statistically significant correlation between endoscopic findings and histopathology reaffirms that visual inspection combined with targeted biopsy remains the absolute gold standard in gastroenterology.

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