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urea breath test for Helicobacter pylori infection in adult dyspeptic patients: A meta-analysis of diagnostic test accuracy

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World Journal of Gastroenterology 2024年第6期30卷 579-598页

作者： 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 Instituto Multidisciplinar em Saúde Universidade Federal da BahiaVitória da Conquista 45029-094BahiaBrazil Instituto de Saúde Coletiva Universidade Federal da BahiaSalvador 40110040BahiaBrazil Campus Toledo Universidade Federal do ParanáToledo 85919-899ParanáBrazil Laboratory of Research in Bacteriology UFMGBelo Horizonte 30130-100Minas GeraisBrazil

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(^(13)C-UBT or ^(14)C-UBT)against a reference standard.We used the QUADAS-2 tool to assess the methodo-logical 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.endorsing both as reliable diagnostic tools in clinical practice.CONCLUSION In summary,our study has demonstrated that ^(13)C-UBT has been found to outperform the ^(14)C-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 cru

关键词： Helicobacter pylori urea breath test Diagnosis Diagnostic test accuracy Meta-analysis

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Evaluation of urea breath test as a diagnostic tool for Helicobacter pylori infection in adult dyspeptic patients

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World Journal of Gastroenterology 2024年第17期30卷 2302-2307页

作者： Zeinab Nabil Ahmed Said Asmaa Mohamed El-Nasser Department of Medical Microbiology&Immunology Faculty of Medicine for Girls Al-Azhar UniversityNasr City 11754CairoEgypt

In this editorial,we discuss the article in the World Journal of Gastroenterology.The article conducts a meta-analysis of the diagnostic accuracy of the urea breath test(UBT),a non-invasive method for detecting Helicobacter pylori(H.pylori)infection in humans.It is based on radionuclide-labeled urea.Various methods,both invasive and non-invasive,are available for diagnosing H.pylori infection,inclu-ding endoscopy with biopsy,serology for immunoglobulin titers,stool antigen analysis,and UBT.Several guidelines recommend UBTs as the primary choice for diagnosing H.pylori infection and for reexamining after eradication therapy.It is used to be the first choice non-invasive test due to their high accuracy,specificity,rapid results,and simplicity.Moreover,its performance remains unaffected by the distribution of H.pylori in the stomach,allowing a high flow of patients to be tested.Despite its widespread use,the performance characteristics of UBT have been inconsistently described and remain incompletely defined.There are two UBTs available with Food and Drug Administration approval:The 13C and 14C tests.Both tests are affordable and can provide real-time results.Physicians may prefer the 13C test because it is non-radioactive,compared to 14C which uses a radioactive isotope,especially in young children and pregnant women.Although there was heterogeneity among the studies regarding the diagnostic accuracy of both UBTs,13C-UBT consistently outperforms the 14C-UBT.This makes the 13C-UBT the preferred diagnostic approach.Furthermore,the provided findings of the meta-analysis emphasize the significance of precise considerations when choosing urea dosage,assessment timing,and measurement techniques for both the 13C-UBT and 14C-UBT,to enhance diagnostic precision.

关键词： Helicobacter pylori urea breath test Diagnosis Diagnostic test accuracy Meta-analysis

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Modified Helicobacter test using a new test meal and a 13C-urea breath test in Helicobacter pylori positive and negative dyspepsia patients on proton pump inhibitors

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World Journal of Gastroenterology 2017年第32期23卷 5954-5961页

作者： Bojan Tepes Peter Malfertheiner Joachim Labenz Sitke Aygen AM DC Rogaska Prvomajska 29 A3250 Rogaska SlatinaSlovenia Universitatsklinikum Magdeburg A.o.R Klinik für Gastroenterologie Hepatologie und Infektiologie39120 MagdeburgGermany Department of Internal Medicine and Gastroenterology Diakonie KlinikumJung-Stilling Hospital Institut für Biomedizinische Analytik und NMR-Imaging GmbH(INFAI)

AIM To determine the sensitivity and specificity of the ^(13)C-urea breath test(UBT) in patients taking proton pump inhibitors(PPIs), using a new test meal Refex. METHODS One hundred and fourteen consecutive patients with dyspepsia, 53 Helicobacter pylori(H. pylori) positive, 49 H. pylori negative, were included in the study. The patients were then given esomeprazole 40 mg for 29 consecutive days, and the ^(13)C-UBT with the new test meal was performed the next morning. RESULTS The sensitivity of the ^(13)C-UBT with a cut off 2.5‰ was92.45%(95%CI: 81.79%-97.91%) by per-protocol(PP) analysis and 78.13 %(95%CI: 66.03%-87.49%) by intention-to-treat(ITT) analysis. The specificity of the ^(13)C-UBT test was 96.00 % in the ITT population(95%CI: 86.29%-99.51%) and 97.96% in the PP population(95%CI: 89.15%-99.95%).CONCLUSION The new test meal based ^(13)C-UBT is highly accurate in patients on PPIs and can be used in those unable to stop their PPI treatment.

关键词： urea breath test new test meal Proton pump inhibitors Prospective randomized clinical trial Helicobacter pylori

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Helicobacter pylori related gastric cancer screening and cost-effectiveness analysis: A hospital-based cross-sectional study（SIGES）

Helicobacter pylori related gastric cancer screening and cos...

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2021年中国肿瘤标志物学术大会暨第十五届肿瘤标志物青...

作者： Wen Xiang Rui Wang Dan Bai Tian-Hang Yu Xin-Zu Chen West China Hospital Sichuan University 宜宾市第二人民医院成都市龙泉驿区第一人民医院

Objectives: To evaluate the effectiveness of Helicobacter pylori（Hp） related gastric cancer screening（HpGCS） and cost-effectiveness of protocol candidates in a hospital-based cross-sectional study.Methods: A total of 163 gastric cancer patients in West China Hospital were retrospectively collected according to ICD-10 code and histologic proof between 2013.4 and 2014.3, and 15,599 cancer-free controls were simultaneously collected from the health check-up registry. Hp infection was examined by urea breath test（UBT）. The prevalence of Hp infection was compared between patients and controls. The diagnostic performance of UBT-based predictive index was tested in both training and validation settings. Cost-effectiveness analysis was conducted to assess candidates of Hp-GCS protocols.Results: The prevalence of Hp infection was 55.8% and 41.2% in gastric cancers and controls, respectively（p＜0.001）. UBT-based model showed moderate diagnostic strength in Hp-GCS（AUC=0.78, 95% CI0.74–0.82）, better than UBT alone（p＜0.001）. The sensitivity and specificity of UBT-based index were80.2% and 61.9% at optimal cutoff in training setting, comparable in validation setting. Number needed to screen was decreased along with older age, as well as stronger positivity of UBT. The optimal cost-effective Hp-GCS protocol with detection rate（DR=77.9%） was endoscopic screening in age 40-59 years and positive UBT, or age ≥60 years without UBT. Incremental analysis suggested preferable protocol as endoscopic screening in age ≥40 years without UBT（DR=93.3%）.Conclusions: UBT had moderate diagnostic strength in massive gastric cancer screening, and might be cost-effective in middle-aged population（40-59 years）. More robust Hp-GCS protocol need further investigate in test methods and individual biologic features.

关键词： Helicobacter pylori urea breath test gastric cancer massive screening cost-effectiveness

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