Abstract
<title>Abstract</title> <p>Background Peptic ulcer disease (PUD) is an important cause of gastrointestinal morbidity in South Asia, yet contemporary endoscopy-based data from Nepal are limited and rarely capture modifiable risk factors. We aimed to estimate the prevalence and anatomical pattern of PUD and to examine its associated risk factors at a tertiary centre in central Nepal. Methods We conducted a retrospective cross-sectional study of 1,242 consecutive adults who underwent upper gastrointestinal endoscopy between April and December 2025. PUD was defined as an endoscopically confirmed gastric and/or duodenal ulcer. A nested case–control analysis matched 224 PUD cases to 448 ulcer-free controls (1:2) on age and sex; drug, lifestyle and comorbidity exposures were abstracted from medical records. Associations were assessed using logistic regression. Results PUD prevalence was 18.0% (224/1,242). The mean age was 49.6 ± 16.6 years and 50.4% were male. Ulcers were gastric-only in 67.4%, duodenal-only in 18.8% and both in 13.8%; the antrum was involved in 67.9% of cases. Among tested patients, Helicobacter pylori positivity was 94.8% and was near-universal in both cases (97.8%) and controls (95.3%), and therefore did not discriminate cases from controls (odds ratio 1.97; p = 0.19). In an exploratory case–control analysis, NSAID use (adjusted odds ratio [aOR] 7.41, 95% CI 2.09–26.29) and ever-smoking (aOR 2.11, 1.08–4.14) were associated with PUD, whereas alcohol, comorbidities, age and sex were not. Conclusions Approximately one in five endoscopy patients had PUD, predominantly antral, with a shift from duodenal towards gastric ulcers across increasing age and in women. Against a background of near-universal H. pylori infection, NSAID use and smoking were associated with ulceration in an exploratory case–control analysis. These contemporary descriptive data provide a baseline for central Nepal and generate hypotheses about modifiable risk factors that warrant confirmation in prospective studies.</p>