Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2024; 30(6): 579-598
Published online Feb 14, 2024. doi: 10.3748/wjg.v30.i6.579
Urea breath test for Helicobacter pylori infection in adult dyspeptic patients: A meta-analysis of diagnostic test accuracy
Fabian Fellipe Bueno Lemos, Caroline Tianeze de Castro, Marcel Silva Luz, Gabriel Reis Rocha, Gabriel Lima Correa Santos, Luís Guilherme de Oliveira Silva, Mariana Santos Calmon, Cláudio Lima Souza, Ana Carla Zarpelon-Schutz, Kádima Nayara Teixeira, Dulciene Maria de Magalhães Queiroz, Fabrício Freire de Melo
Fabian Fellipe Bueno Lemos, Marcel Silva Luz, Gabriel Reis Rocha, Gabriel Lima Correa Santos, Luís Guilherme de Oliveira Silva, Mariana Santos Calmon, Cláudio Lima Souza, Fabrício Freire de Melo, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
Caroline Tianeze de Castro, Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador 40110040, Bahia, Brazil
Ana Carla Zarpelon-Schutz, Kádima Nayara Teixeira, Campus Toledo, Universidade Federal do Paraná, Toledo 85919-899, Paraná, Brazil
Dulciene Maria de Magalhães Queiroz, Laboratory of Research in Bacteriology, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
Author contributions: Lemos FFB, Castro CT, Silva Luz M, Queiroz DMM, and Freire de Melo F contributed to the conceptualization of the manuscript; Lemos FFB, Castro CT, Queiroz DMM and Freire de Melo F designed the study methodology; Lemos FFB, Castro CT, Calmon MS, Silva Luz M, Rocha GR, Correa Santos GL, de Oliveira Silva LG, Calmon MS were responsible for manuscript visualization; Lemos FFB, Castro CT, Calmon MS, Silva Luz M, Rocha GR, Correa Santos GL, de Oliveira Silva LG, Calmon MS contributed to the investigation; Lemos FFB, Castro CT, Calmon MS, Silva Luz M, Rocha GR, Correa Santos GL, de Oliveira Silva LG, Calmon MS performed formal analysis; Lemos FFB and Castro CT wrote the original draft; Castro CT and Queiroz DMM were responsible for manuscript editing; Castro CT, Teixeira KN, Souza CL, and Queiroz DMM were responsible for manuscript writing and review; Freire de Melo F supervised the writing of the original draft.
Supported by Scientific Initiation Scholarship Programme (PIBIC) of the Bahia State Research Support Foundation; the Doctorate Scholarship Program of the Coordination of Improvement of Higher Education Personnel; the Scientific Initiation Scholarship Programme (PIBIC) of the National Council for Scientific and Technological Development; and the CNPq Research Productivity Fellowship.
Conflict-of-interest statement: The authors declare no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fabrício Freire de Melo, PhD, Professor, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Estrada do Bem Querer, No. 3293-3391- Candeias, Vitória da Conquista 45029-094, Bahia, Brazil. freiremeloufba@gmail.com
Received: November 14, 2023
Peer-review started: November 14, 2023
First decision: December 5, 2023
Revised: December 16, 2023
Accepted: January 16, 2024
Article in press: January 16, 2024
Published online: February 14, 2024
Abstract
BACKGROUND

Helicobacter pylori (H. pylori) infection has been well-established as a significant risk factor for several gastrointestinal disorders. The urea breath test (UBT) has emerged as a leading non-invasive method for detecting H. pylori. Despite numerous studies confirming its substantial accuracy, the reliability of UBT results is often compromised by inherent limitations. These findings underscore the need for a rigorous statistical synthesis to clarify and reconcile the diagnostic accuracy of the UBT for the diagnosis of H. pylori infection.

AIM

To determine and compare the diagnostic accuracy of 13C-UBT and 14C-UBT for H. pylori infection in adult patients with dyspepsia.

METHODS

We conducted an independent search of the PubMed/MEDLINE, EMBASE, and Cochrane Central databases until April 2022. Our search included diagnostic accuracy studies that evaluated at least one of the index tests (13C-UBT or 14C-UBT) against a reference standard. We used the QUADAS-2 tool to assess the methodological quality of the studies. We utilized the bivariate random-effects model to calculate sensitivity, specificity, positive and negative test likelihood ratios (LR+ and LR-), as well as the diagnostic odds ratio (DOR), and their 95% confidence intervals. We conducted subgroup analyses based on urea dosing, time after urea administration, and assessment technique. To investigate a possible threshold effect, we conducted Spearman correlation analysis, and we generated summary receiver operating characteristic (SROC) curves to assess heterogeneity. Finally, we visually inspected a funnel plot and used Egger’s test to evaluate publication bias.

RESULTS

The titles and abstracts of 4621 studies were screened; 79 articles were retrieved and selected for full-text reading. Finally, 60 studies were included in the diagnostic test accuracy meta-analysis. Our analysis demonstrates superior diagnostic accuracy of 13C-UBT over 14C-UBT, indicated by higher sensitivity (96.60% vs 96.15%), specificity (96.93% vs 89.84%), likelihood ratios (LR+ 22.00 vs 10.10; LR- 0.05 vs 0.06), and area under the curve (AUC; 0.979 vs 0.968). Notably, 13C-UBT's DOR (586.47) significantly outperforms 14C-UBT (DOR 226.50), making it the preferred diagnostic tool for dyspeptic individuals with H. pylori infection. Correlation analysis revealed no threshold effect (13C-UBT: r = 0.48; 14C-UBT: r = -0.01), and SROC curves showed consistent accuracy. Both 13C-UBT and 14C-UBT showed high AUC values (13C-UBT 0.979; 14C-UBT 0.968) near 1.00, reinforcing their excellent accuracy and endorsing both as reliable diagnostic tools in clinical practice.

CONCLUSION

In summary, our study has demonstrated that 13C-UBT has been found to outperform the 14C-UBT, making it the preferred diagnostic approach. Additionally, our results emphasize the significance of carefully considering urea dosage, assessment timing, and measurement techniques for both tests to enhance diagnostic precision. Nevertheless, it is crucial for researchers and clinicians to evaluate the strengths and limitations of our findings before implementing them in practice.

Keywords: Helicobacter pylori, Urea breath test, Diagnosis, Diagnostic test accuracy, Meta-analysis

Core Tip: The urea breath test (UBT) is a pivotal noninvasive method for detecting Helicobacter pylori (H. pylori); however, its reliability is challenging. This meta-analysis aimed to compare the precision of the 13C-UBT and 14C-UBT in diagnosing H. pylori among adults with dyspepsia, providing insights to enhance clinical strategies.