Accuracy of the Helicobacter pylori diagnostic tests in patients with peptic ulcer bleeding: a systematic review and network meta-analysis

Abstract

Introduction: Some studies suggest that the accuracy of Helicobacter pylori diagnostic tests is decreased in peptic ulcer bleeding (PUB). We aimed to assess the accuracy of diagnostic tests for H. pylori in patients with PUB in a diagnostic test accuracy (DTA) network meta-analysis. Methods: A systematic search was carried out in seven databases until November 2019. We collected or calculated true and false positive and negative values, and constructed 2×2 diagnostic contingency tables with reference standards including histology, rapid urease test, urea breath test, serology, stool antigen test, culture, and polymerase chain reaction. We ranked the index tests by the superiority indices (SI) and calculated pooled sensitivity and specificity of each test. Discussion: Our search yielded 40 eligible studies with 27 different diagnostic strategies for H. pylori. In 32 articles, the reference standard was a combination of multiple tests. In 12 studies, the index tests were compared with a single testing method. We analyzed seven networks with the reference standards against a single or a combination of diagnostic index tests. None of the index tests had better diagnostic accuracy (SI between 9.94 and 2.17) compared with the individual index tests as all the confidence intervals included 1. Combined testing strategies had higher sensitivities (0.92–0.62) and lower specificities (0.85–0.46) while single tests proved to have higher specificities (0.83–0.77) and lower sensitivities (0.73–0.42). Conclusion: Use of combined tests may have a rationale in clinical practice due to their higher sensitivities. The differences between the included DTA studies limited the comparison of the testing strategies.

Diagnostic performance of fecal Helicobacter pylori antigen test in Uganda

“…Studies comparing SAT to immunohistological H. pylori testing in low-income settings show a low sensitivity [ 15 , 16 ] perhaps because most individuals tested had bleeding peptic ulcers, a known cause of false-positive H. pylori [ 17 ]. However, using similar comparison methods of SAT with immunohistology, Erzin et al [ 18 ] found high sensitivity and low specificity compared to this current study.…”

Prophylactic transcatheter arterial embolization reduces rebleeding in non-variceal upper gastrointestinal bleeding: A meta-analysis

“…After peptic ulcer bleeding, investigation for the presence of H. pylori should be mandatory. Our network meta-analysis[ 36 ] demonstrated that none of the individual tests or the strategy of combined tests is superior in detecting H. pylori . Gisbert et al [ 37 ] reported that rebleeding did not occur in patients with complicated ulcers after H. pylori eradication; moreover, maintenance of anti-ulcer therapy is unnecessary if eradication was achieved.…”

Pepsinogen and Serum IgG Detection Is a Valuable Diagnostic Method for Helicobacter pylori Infection in a Low-Prevalence Country: A Report from Sri Lanka

“…A previous study reported the prevalence in Sri Lanka using the stool antigen test and PCR [9,11,12]. A recent systematic review that compared the accuracy of diagnostic tests ranked the quality according to the superiority index range from 2.17 to 9.94 [13]. For the PCR and stool antigen, the highest superiority index was only 4.99 for the PCR and 3.87 for the stool antigen.…”

“…Detection of H. pylori infection can be obtained via invasive and non-invasive measures. Detection of H. pylori through upper endoscopy, gastric biopsy, and culture provides evidence of infection [13,14]. It can also reveal the condition of the stomach and allow for the investigation of abnormal development of the gastric mucosa.…”