Diagnostic Performance of Urea Breath Test, Rapid Urea Test, and Histology for Helicobacter pylori Infection in Patients With Partial Gastrectomy A Meta-analysis

Background: Helicobacter pylori infection has been implicated in the pathogenesis of gastroduodenal diseases such as recurrent peptic ulceration and particularly residual stomach cancer in the postoperative stomach. Aim: To determine the performance of different commonly used tests for the diagnosis of H. pylori infection in patients after partial gastrectomy. Methods: A systematic literature search was conducted by searching the PubMed, EMBASE and ScienceDirect databases with relevant key words. Data extraction was independently performed by two reviewers. Meta-analyses were performed for the performance of the different tests including the sensitivities, specificities, likelihood ratios (LRs), diagnostic odds ratio diagnostic odds ratio, and the summary receiver operating characteristic summary receiver operating characteristic curve. The meta-analysis was performed by Meta-DiSc software. Results: Studies showed a high degree of heterogeneity. Pooled sensitivity, specificity, LR+, LR- and diagnostic odds ratio for the different methods were: Urea breath test (9 studies): 0.77 (95% CI, 0.72-0.82), 0.89 (95% CI, 0.85-0.93), 6.32 (95% CI, 3.22-12.42), 0.27 (95% CI, 0.17-0.43), and 27.86 (95% CI, 13.27-58.49). Rapid urease test (7 studies): 0.79 (95% CI, 0.72-0.84), 0.94 (95% CI, 0.90-0.97), 10.21 (95% CI, 5.94-17.54), 0.28 (95% CI, 0.22-0.36) and 49.02 (95% CI, 24.24-99.14). Histology (3 studies): 0.93 (95% CI, 0.88-0.97), 0.85 (95% CI, 0.73-0.93), 5.88 (95% CI, 3.26-10.60), 0.09 (95% CI, 0.05-0.15), and 97.28 (95% CI, 34.30-275.95). The corresponding summary receiver operating characteristic curves showed areas under the curves of 0.91, 0.93 and 0.96 and Q* values of 0.84, 0.86 and 0.91, respectively Conclusion: Among the three commonly used tests, histological examination performs the best, followed by the rapid urease test, for the diagnosis of H. pylori infection after partial gastrectomy. Thus, histology, preferably after the rapid urease test, is recommended for the diagnosis of H. pylori infection after partial gastrectomy.