Diagnostic accuracy of the ¹⁴C-urea breath test in Helicobacter pylori infections: a meta-analysis

To summarize and appraise the available literature regarding the use of the ¹⁴C-urea breath test in the diagnosis of Helicobacter pylori infections in adult patients with dyspepsia and to calculate pooled diagnostic accuracy measures.

We systematically searched the PubMed, EMBASE, Cochrane Library, Chinese Journals Full-text (CNKI) and CBMDisc databases to identify published data regarding the sensitivity, specificity, and other measures of diagnostic accuracy of the ¹⁴C-urea breath test in the diagnosis of Helicobacter pylori infections in adult patients with dyspeptic symptoms. Risk of bias was assessed using the QUADAS (Quality Assessment of Diagnostic Accuracy Studies)-2 tool. Statistical analyses were performed using Meta-Disc 1.4 software and STATA.

Eighteen studies met the inclusion criteria. Pooled results indicated that the ¹⁴C-urea breath test showed a diagnostic sensitivity of 0.96 (95% CI 0.95 to 0.96) and specificity of 0.93 (95% CI 0.91 to 0.94). The positive like ratio (PLR) was 12.27 (95% CI 8.17 to 18.44), the negative like ratio (NLR) was 0.05 (95% CI 0.04 to 0.07), and the area under the curve was 0.985. The DOR was 294.95 (95% CI 178.37 to 487.70). The ¹⁴C-urea breath test showed sufficient sensitivity and specificity for diagnosing Helicobacter pylori infection, but unexplained heterogeneity after meta-regression and several subgroup analyses remained.