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Twenty people visiting a religious shrine in Pakistan were murdered on Sunday, in a crime blamed on the building's custodian and two accomplices arrested by police.

Four women were among those killed at the Sufi shrine to Mohammed Ali in the Punjab province, according to police.

The three suspects were arrested for intoxicating and murdering 20 devotees with batons and knives early on Sunday, police added.

"The 50-year-old shrine custodian Abdul Waheed has confessed that he killed these people because he feared that they had come to kill him," regional police chief Zulfiqar Hameed told AFP.

"The suspect appears to be paranoid and psychotic, or it could be related to rivalry for the control of shrine," he said, adding that the investigation was continuing.

Local police station chief Shamshir Joya said the victims, whose clothes were torn and bloodstained, appeared to have been given intoxicants.

"We suspect that the victims had been given some intoxicants before they were murdered, but we will wait for a forensics report to confirm this suspicion," he added.

Joya said the shrine was built in the area some two and a half years ago. When its former custodian died,  Waheed - a one-time employee of the national election commission - took over.

Punjab Chief Minister Shahbaz Sharif has called for a police report on the investigation within 24 hours, a senior government official said.

Sufi tradition

Visiting shrines and offering alms for the poor - as well as cash to the custodians - remains a very popular custom in Pakistan where many believe these acts will help get their prayers answered.

For centuries, Pakistan was a land of Sufism, a mystical branch of Islam whose wandering holy men helped spread the religion throughout the Indian subcontinent in the 13th century.

Sufis believe in saints which they say can intercede for them directly with God. They have no hierarchy or organisation, instead seeking spiritual communion through music and dance at the shrines of the saints.

Several million Muslims in Pakistan are still believed to follow Sufism, although it has overtaken in recent decades by more conservative versions of the faith.

Hardliners such as the Taliban or the Islamic State group have carried out major attacks on Sufi shrines because they consider them to be out of the fold of Islam.

In February, 88 people were killed and hundreds wounded in Pakistan's southern province of Sindh when a suicide bomber blew himself up among devotees at a Sufi shrine.