Zhongguo quanke yixue (Jan 2022)
Urease Breath Test and Stool Antigen Test Diagnose Helicobacter Pylori Infection in Patients with Bleeding Peptic Ulcer：a Meta-analysis
Abstract
BackgroundIn patients with peptic ulcer bleeding (PUB) , intragastric blood and unavoidable medicine, including acid suppressive agent are suspected as limitary factors to diagnose Helicobacter pylori (H.pylori) infection correctly. The research conclusions about the accuracy of urease breath test (UBT) and stool antigen test (SAT) in patients with PUB are inconsistent.ObjectiveTo clarify the accuracy of UBT and SAT for H.pylori infection in PUB patients.MethodsPubMed, EMBase, the Cochrane Library, Web of Science, CNKI, Wanfang Data Knowledge Service Platform, China Biomedical Literature Database (CBM) were retrieved by computer for relevant articles related to the diagnosis of H.pylori infection by UBT and/or SAT published from the establishment of the database to March 31, 2021. The QUADAS-2 tool was used to evaluate the quality of the extracted literature. The bivariate mixed-effects regression model and network meta-analysis model (NMA) were used to synthesize diagnostic test data. Meta-regression and subgroup analysis were performed to explore the sources of heterogeneity.ResultsA total of 18 articles were included, with a total of 25 studies and 1 105 patients. Meta-analysis results showed that the combined sensitivity of UBT and SAT for diagnosing H.pylori infection in PUB patients were 0.90〔95%CI (0.79, 0.95) 〕 and 0.89〔95%CI (0.81, 0.94) 〕, the combined specificity were 0.91〔95%CI (0.86, 0.95) 〕 and 0.75〔95%CI (0.59, 0.87) 〕, the combined diagnostic odds ratio were 88.89〔95%CI (31.01, 254.82) 〕 and 24.35〔95%CI (13.76, 43.09) 〕, the combined positive likelihood ratio were 10.07〔95%CI (6.07, 16.71) 〕 and 3.60〔95%CI (2.11, 6.12) 〕, the combined negative likelihood ratio were 0.11〔95%CI (0.05, 0.24) 〕 and 0.15〔95%CI (0.09, 0.24) 〕, the area under the SROC curve were 0.93〔95%CI (0.90, 0.95) 〕 and 0.91〔95%CI (0.88, 0.93) 〕. Meta regression showed that the sampling time had an impact on the sensitivity heterogeneity of UBT and SAT, and the sampling time and the H.pylori infection criterion had an impact on the combined specificity heterogeneity of UBT. The Deek funnel chart indicated that there was no potential publication bias among the included researches (PUBT=0.53, PSAT=0.64) .ConclusionIn patients with PUB, UBT had a promising performance for the diagnosis of H.pylori infection. Because of the high number of false-positive results, SAT was not recommended for use in patients with PUB alone. At the same time, in order to avoid the impact of PPI on the detection results, it was recommended to perform the diagnostic tests as soon as possible under the condition of stable hemodynamics.
Keywords
