Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2015; 21(4): 1305-1314
Published online Jan 28, 2015. doi: 10.3748/wjg.v21.i4.1305
Accuracy of urea breath test in Helicobacter pylori infection: Meta-analysis
Mazen Ferwana, Imad Abdulmajeed, Ali Alhajiahmed, Wedad Madani, Belal Firwana, Rim Hasan, Osama Altayar, Paul J Limburg, Mohammad Hassan Murad, Bandar Knawy
Mazen Ferwana, Imad Abdulmajeed, Ali Alhajiahmed, Wedad Madani, Bandar Knawy, National and Gulf Center for Evidence-Based Health Practice, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia
Belal Firwana, Rim Hasan, Department of Medicine, University of Missouri Columbia, Missouri, MO 65211, United States
Belal Firwana, Rim Hasan, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 65212, United States
Osama Altayar, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, United States
Osama Altayar, Department of Internal Medicine, Allegheny General Hospital, Pittsburg, PA 55905, United States
Paul J Limburg, Division of Gastroenterology, Mayo Clinic, Rochester, MN 55905, United States
Mohammad Hassan Murad, Division of Preventive Medicine, Mayo Clinic, Rochester, MN 55905, United States
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mazen Ferwana, MD, ABFM, JBFM, PhD, National and Gulf Center for Evidence-Based Health Practice, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, P.O. Box 22490, Mail code 3120, Riyadh 11426, Saudi Arabia. ferwanam@ngha.med.sa
Telephone: +966-11-4291167 Fax: +966-11-4291193
Received: March 11, 2014
Peer-review started: March 11, 2014
First decision: March 27, 2014
Revised: May 19, 2014
Accepted: June 14, 2014
Article in press: June 17, 2014
Published online: January 28, 2015
Abstract

AIM: To quantitatively summarize and appraise the available evidence of urea breath test (UBT) use to diagnose Helicobacter pylori (H. pylori) infection in patients with dyspepsia and provide pooled diagnostic accuracy measures.

METHODS: We searched MEDLINE, EMBASE, Cochrane library and other databases for studies addressing the value of UBT in the diagnosis of H. pylori infection. We included cross-sectional studies that evaluated the diagnostic accuracy of UBT in adult patients with dyspeptic symptoms. Risk of bias was assessed using QUADAS (Quality Assessment of Diagnostic Accuracy Studies)-2 tool. Diagnostic accuracy measures were pooled using the random-effects model. Subgroup analysis was conducted by UBT type (13C vs14C) and by measurement technique (Infrared spectrometry vs Isotope Ratio Mass Spectrometry).

RESULTS: Out of 1380 studies identified, only 23 met the eligibility criteria. Fourteen studies (61%) evaluated 13C UBT and 9 studies (39%) evaluated 14C UBT. There was significant variation in the type of reference standard tests used across studies.Pooled sensitivity was 0.96 (95%CI: 0.95-0.97) andpooled specificity was 0.93 (95%CI: 0.91-0.94). Likelihood ratio for a positive test was 12 and for a negative test was 0.05 with an area under thecurve of 0.985. Meta-analyses were associated with a significant statistical heterogeneity that remained unexplained after subgroup analysis. The included studies had a moderate risk of bias.

CONCLUSION: UBT has high diagnostic accuracy for detecting H. pylori infection in patients with dyspepsia. The reliability of diagnostic meta-analytic estimates however is limited by significant heterogeneity.

Keywords: Helicobacter pylori, Dyspepsia, Breath tests, Urea/analysis, Diagnosis, Sensitivity, Specificity, Gastritis, Positive predictive value, Negative predictive value

Core tip: Urea breath test (UBT) is a commonly used non-invasive test to diagnose Helicobacter pylori (H. pylori) infection in patients with dyspepsia. Multiple trials are available in literature, but they reported different diagnostic accuracy estimates. We conducted systemic review and meta-analysis to explore the available evidence and provide pooled diagnostic accuracy measures. Our meta-analysis showed that UBT has high diagnostic accuracy for detecting H. pylori infection in patients with dyspepsia. Given the potentially preventable diseases associated with chronic, untreated H. pylori infection, more widespread adoption of UBT testing may be indicated.