13C-Urea Breath Test Accuracy for Helicobacter pylori Infection in the Asian Population: A Meta-Analysis

Muhammad Aklil Abd Rahim; Fadzrul Hafiz Johani; Shamsul Azhar Shah; Mohd Rohaizat Hassan; Mohd Rizal Abdul Manaf

doi:10.5334/aogh.2570

13C-Urea Breath Test Accuracy for Helicobacter pylori Infection in the Asian Population: A Meta-Analysis

Volume 85 (2019): Issue 1

By: Muhammad Aklil Abd Rahim , Fadzrul Hafiz Johani, Shamsul Azhar Shah, Mohd Rohaizat Hassan and Mohd Rizal Abdul Manaf

Open Access

|Jul 2019

Abstract

Background: Helicobacter pylori (H. pylori) infection is known to be associated with peptic ulcer and gastric cancer. Detection of H. pylori infection is a significant part of peptic ulcer and gastric cancer prevention and management. ¹³C-urea breath test (UBT) provides a good option for the pathogen detection due to its accuracy and safety.

Objective: This review aims to evaluate the ¹³C-UBT diagnostic accuracy studies conducted among Asian population and validate its use for the Asian population.

Methods: Original articles were systematically searched in PubMed, Scopus, and Google Scholar using the PICOS strategy by applying relevant keywords. Only studies published in English and conducted in Asia were included. Our search returned 276 articles. After assessment, 11 articles which answered our research question and met the criteria set for systematic review and meta-analysis were accepted. A total of 15 study protocols were extracted from the 11 accepted articles.

Findings: Majority of the studies were conducted in Hong Kong (six), followed by Taiwan (five), Japan (two), and one each in Singapore and Israel. All studies had used histology as part of its gold standard of reference. All but one study was performed on adult populations. The summary estimate for sensitivity was 97% (95% CI: 96, 98%), and specificity was 96% (95% CI: 95, 97%), with significant heterogeneity between studies. Adjusting for the dose (50 mg) and breath sample collection time (20 minutes) had improved both accuracy estimates and significantly reduced heterogeneity.

Conclusion: This review supports the test-and-treat strategy for H. pylori infection management. Prevalence and cost-effectiveness studies are mandatory for health authorities to adopt this strategy into national policy.

References

Stewart BW and Wild CP. World Cancer Report 2014; 2014. http://www.searo.who.int/publications/bookstore/documents/9283204298/en/. ISBN: 9283204298.
Search in Google Scholar Back to article
Marshall BJ and Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet. 1984; 323(8390): 1311–1315. DOI: 10.1016/S0140-6736(84)91816-6
Open DOI Search in Google Scholar Back to article
Gisbert JP and Pajares JM. Review article: ¹³C-urea breath test in the diagnosis of helicobacter pylori infection – A critical review. Aliment Pharmacol Ther. 2004; 20(10): 1001–1017. DOI: 10.1111/j.1365-2036.2004.02203.x
Open DOI Search in Google Scholar Back to article
Fock KM, Katelaris P, Sugano K, et al. Second Asia-Pacific consensus guidelines for Helicobacter pylori infection. J Gastroenterol Hepatol. 2009; 24(10): 1587–1600. DOI: 10.1111/j.1440-1746.2009.05982.x
Open DOI Search in Google Scholar Back to article
Malfertheiner P, Megraud F, O’Morain CA, et al. Management of helicobacter pylori infection—the Maastricht V/Florence consensus report. Gut. 2017; 66(1): 6–30. DOI: 10.1136/gutjnl-2016-312288
Open DOI Search in Google Scholar Back to article
Leal YA, Flores LL, Fuentes-Pananá EM, Cedillo-Rivera R and Torres J. ¹³C-Urea breath test for the diagnosis of Helicobacter pylori infection in children: A systematic review and meta-analysis. Helicobacter. 2011; 16(4): 327–337. DOI: 10.1111/j.1523-5378.2011.00863.x
Open DOI Search in Google Scholar Back to article
Tian XY, Zhu H, Zhao J, She Q and Zhang GX. Diagnostic performance of urea breath test, rapid urea test, and histology for helicobacter pylori infection in patients with partial gastrectomy: A meta-analysis. J Clin Gastroenterol. 2012; 46(4): 285–292. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed10&NEWS=N&AN=2012174449. DOI: 10.1097/MCG.0b013e318249c4cd
Open DOI Search in Google Scholar Back to article
Gisbert JP and Abraira V. Accuracy of Helicobacter pylori diagnostic tests in patients with bleeding peptic ulcer: A systematic review and meta-analysis. Am J Gastroenterol. 2006; 101(4): 848–863. DOI: 10.1111/j.1572-0241.2006.00528.x
Open DOI Search in Google Scholar Back to article
Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. J Clin Epidemiol. 2009; 62. DOI: 10.1016/j.jclinepi.2009.06.006
Open DOI Search in Google Scholar Back to article
Whiting P, Rutjes AWS, Reitsma JB, Bossuyt PMM and Kleijnen J. The development of QUADAS: A tool for quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol. 2003; 3(25): 1–13. DOI: 10.1186/1471-2288-3-25
Open DOI Search in Google Scholar Back to article
Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: A revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011; 155: 529–536. DOI: 10.7326/0003-4819-155-8-201110180-00009
Open DOI Search in Google Scholar Back to article
Whiting P, Harbord R and Kleijnen J. No role for quality scores in systematic reviews of diagnostic accuracy studies. BMC Med Res Methodol. 2005; 5(19). DOI: 10.1186/1471-2288-5-19
Open DOI Search in Google Scholar Back to article
Zamora J, Abraira V, Muriel A, Khan K and Coomarasamy A. Meta-DiSc: A software for meta-analysis of test accuracy data. BMC Med Res Methodol. 2006; 6(31). DOI: 10.1186/1471-2288-6-31
Open DOI Search in Google Scholar Back to article
Chua TS, Fock KM, Teo EK and Ng TM. Validation of ¹³C-urea breath test for the diagnosis of Helicobacter pylori infection in the Singapore population. Singapore Med J. 2002; 43(8): 408–411.
Search in Google Scholar Back to article
Kato S, Ozawa K, Konno M, et al. Diagnostic accuracy of the ¹³C-urea breath test for childhood helicobacter pylori infection: A multicenter Japanese study. Am J Gastroenterol. 2002; 97(7): 1668–1673. DOI: 10.1016/S0002-9270(02)04181-3
Open DOI Search in Google Scholar Back to article
Wong WM, Lam SK, Lai KC, et al. A rapid-release 50-mg tablet-based 13 C-urea breath test for the diagnosis of Helicobacter pylori infection. Aliment Pharmacol Ther. 2003; 17: 253–257. DOI: 10.1046/j.0269-2813.2003.01417.x
Open DOI Search in Google Scholar Back to article
Peng NJ, Lai KH, Liu RS, et al. Capsule ¹³C-urea breath test for the diagnosis of helicobacter pylori infection. World J Gastroenterol. 2005; 11(9): 1361–1364. DOI: 10.3748/wjg.v11.i9.1361
Open DOI Search in Google Scholar Back to article
Peng NJ, Hsu PI, Lee SC, et al. A 15-minute [¹³C]-urea breath test for the diagnosis of Helicobacter pylori infection in patients with non-ulcer dyspepsia. J Gastroenterol Hepatol. 2000; 15(3): 284–289. DOI: 10.1046/j.1440-1746.2000.02159.x
Open DOI Search in Google Scholar Back to article
Urita Y, Hike K, Torii N, et al. Breath sample collection through the nostril reduces false-positive results of ¹³C-urea breath test for the diagnosis of helicobacter pylori infection. Dig Liver Dis. 2004; 36(10): 661–665. DOI: 10.1016/j.dld.2004.06.008
Open DOI Search in Google Scholar Back to article
Wang WM, Lee SC, Ding HJ, et al. Quantification of Helicobacter pylori infection: Simple and rapid ¹³C-urea breath test in Taiwan. J Gastroenterol. 1998; 33(3): 330–335. DOI: 10.1007/s005350050092
Open DOI Search in Google Scholar Back to article
Wong B, Wong WM, Wang WH, et al. An evaluation of invasive and non-invasive tests for the diagnosis of Helicobacter pylori infection in Chinese. Aliment Pharmacol Ther. 2001: 505–511. DOI: 10.1046/j.1365-2036.2001.00947.x
Open DOI Search in Google Scholar Back to article
Wardi J, Shalev T, Shevah O, Boaz M, Avni Y and Shirin H. A rapid continuous-real-time ¹³C-urea breath test for the detection of helicobacter pylori in patients after partial gastrectomy. J Clin Gastroenterol. 2012; 46(4): 293–296. DOI: 10.1097/MCG.0b013e31823eff09
Open DOI Search in Google Scholar Back to article
Wong WM, Wong BCY, Li TM, et al. Twenty-minute 50 mg ¹³C-urea breath test without test meal for the diagnosis of Helicobacter pylori infection in Chinese. Aliment Pharmacol Ther. 2001; 15(9): 1499–1504. DOI: 10.1046/j.1365-2036.2001.01078.x
Open DOI Search in Google Scholar Back to article
Wong WM, Wong BCY, Wong KW, et al. ¹³C-urea breath test without a test meal is highly accurate for the detection of Helicobacter pylori infection in Chinese. Aliment Pharmacol Ther. 2000; 14(10): 1353–1358. DOI: 10.1046/j.1365-2036.2000.00843.x
Open DOI Search in Google Scholar Back to article
Klein PD, Malaty HM, Czinn SJ, Emmons SJ, Martin RF and Graham DY. Normalizing results of 13 C-Urea breath besting for CO₂ production rates in children. J Pediatr Gastroenterol Nutr. 1999; 29(3): 297–301. DOI: 10.1097/00005176-199909000-00011
Open DOI Search in Google Scholar Back to article
Slater C, Preston T and Weaver LT. Is there an advantage in normalising the results of the Helicobacter pylori [¹³C] urea breath test for CO₂ production rate in children? Isotopes Environ Health Stud. 2004; 40(1): 89–98. DOI: 10.1080/10256010310001621164
Open DOI Search in Google Scholar Back to article
Ford AC, Qume M, Moayyedi P, et al. Helicobacter pylori “test and treat” or endoscopy for managing dyspepsia: An individual patient data meta-analysis. Gastroenterology. 2005; 128(7): 1838–1844. DOI: 10.1053/j.gastro.2005.03.004
Open DOI Search in Google Scholar Back to article
Fuccio L, Zagari RM, Eusebi LH, et al. Meta-analysis: Can Helicobacter pylori eradication treatment reduce the risk for gastric cancer? Ann Intern Med. 2009; 151(2): 121–128. DOI: 10.7326/0003-4819-151-2-200907210-00009
Open DOI Search in Google Scholar Back to article
Ma J, Zhang L, Brown LM, et al. Fifteen-year effects of Helicobacter pylori, garlic, and vitamin treatments on gastric cancer incidence and mortality. J Natl Cancer Inst. 2012; 104(6): 488–492. DOI: 10.1093/jnci/djs003
Open DOI Search in Google Scholar Back to article

Articles in this issue

DOI: https://doi.org/10.5334/aogh.2570 | Journal eISSN: 2214-9996

Journal RSS Feed

Language: English

Published on: Jul 24, 2019

Published by: Ubiquity Press

In partnership with: Paradigm Publishing Services

Publication frequency: 1 issue per year

© 2019 Muhammad Aklil Abd Rahim, Fadzrul Hafiz Johani, Shamsul Azhar Shah, Mohd Rohaizat Hassan, Mohd Rizal Abdul Manaf, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 85 (2019): Issue 1