Physicians’ knowledge, attitudes, and practices related to the management of Helicobacter pylori-induced gastric ulcers: a questionnaire-based, cross-sectional study in Pakistan

Introduction: In South Asia, the prevalence of Helicobacter pylori (H. pylori) infections may be as high as 60-80%, constituting a notable public health issue, with eradication strategies critical in reducing the H. pylori-associated disease burden. The aim of our study was to assess the knowledge, attitude and practices (KAP) regarding the screening, treatment, and follow-up of H. pylori-induced gastric ulcers among physicians in Lahore, Pakistan.

Methods: A self-administered, questionnaire-based cross-sectional study—including the development and validity assessment of a 25-item questionnaire—was carried out in two tertiary-care hospitals between January and May 2024. Statistical analyses (descriptive statistics, χ²-tests, binary logistic regression; 95% confidence interval [95%CI]) were carried out using SPSS 27.0. The study followed the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines.

Results: Among N=385 participants, 57.9% were male, 60.0% were aged between 25 and 34 years, 59.5% worked in a public hospital, and 55.3% had <5 years of working experience. A total of 32.9% had noted medical journals, while 27.0% reported online educational materials as their key sources of evidence-based information. Although 91.2% and 87.3% of physicians had good knowledge and attitude levels (≥50% score) pertaining to H. pylori-associated gastric ulcers, respectively, only 49.6% correctly identified H. pylori as being contagious. Participants aged 25–34 years (aOR: 0.217 [95% CI: 0.08-0.589]), who have <5 years of working experience (aOR: 0.328 [95% CI: 0.136-0.790]) and those working in public hospitals (aOR: 0.130 [95% CI: 0.048-0.352]) were less likely to show poor attitudes. A total of 76.5% made it routine to discuss the risk factors of H. pylori-induced ulcers with their patients, while 67.4% highlighted the importance of follow-up testing to confirm the eradication of H. pylori.

Conclusions: Inconsistent and empirical treatment approaches, and lack of routine screening and follow-up practices may further compromise eradication efforts, and contribute to the development of multidrug-resistance in H. pylori.