title: Accuracy of urea breath test in Helicobacter pylori infection: meta-analysis.
abstract: OBJECTIVE
  To quantitatively summarize and appraise the available evidence of urea breath test (UBT) use to diagnose Helicobacter pylori (H. pylori) infection in patients with dyspepsia and provide pooled diagnostic accuracy measures.
  
  
  METHODS
  We searched MEDLINE, EMBASE, Cochrane library and other databases for studies addressing the value of UBT in the diagnosis of H. pylori infection. We included cross-sectional studies that evaluated the diagnostic accuracy of UBT in adult patients with dyspeptic symptoms. Risk of bias was assessed using QUADAS (Quality Assessment of Diagnostic Accuracy Studies)-2 tool. Diagnostic accuracy measures were pooled using the random-effects model. Subgroup analysis was conducted by UBT type (13C vs 14C) and by measurement technique (Infrared spectrometry vs Isotope Ratio Mass Spectrometry).
  
  
  RESULTS
  Out of 1380 studies identified, only 23 met the eligibility criteria. Fourteen studies (61%) evaluated 13C UBT and 9 studies (39%) evaluated 14C UBT. There was significant variation in the type of reference standard tests used across studies.Pooled sensitivity was 0.96 (95%CI: 0.95-0.97) andpooled specificity was 0.93 (95%CI: 0.91-0.94). Likelihood ratio for a positive test was 12 and for a negative test was 0.05 with an area under thecurve of 0.985. Meta-analyses were associated with a significant statistical heterogeneity that remained unexplained after subgroup analysis. The included studies had a moderate risk of bias.
  
  
  CONCLUSIONS
  UBT has high diagnostic accuracy for detecting H. pylori infection in patients with dyspepsia. The reliability of diagnostic meta-analytic estimates however is limited by significant heterogeneity.
authors: Mazen Ferwana, Imad Abdulmajeed, Ali Alhajiahmed, Wedad Madani, Bandar Knawy, National and Gulf Center for Evidence-Based Health Practice, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia.
authors: Mazen
authors: M
authors: Ferwana
authors: Mazen Ferwana, Imad Abdulmajeed, Ali Alhajiahmed, Wedad Madani, Bandar Knawy, National and Gulf Center for Evidence-Based Health Practice, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia.
authors: Imad
authors: I
authors: Abdulmajeed
authors: Mazen Ferwana, Imad Abdulmajeed, Ali Alhajiahmed, Wedad Madani, Bandar Knawy, National and Gulf Center for Evidence-Based Health Practice, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia.
authors: Ali
authors: A
authors: Alhajiahmed
authors: Mazen Ferwana, Imad Abdulmajeed, Ali Alhajiahmed, Wedad Madani, Bandar Knawy, National and Gulf Center for Evidence-Based Health Practice, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia.
authors: Wedad
authors: W
authors: Madani
authors: Mazen Ferwana, Imad Abdulmajeed, Ali Alhajiahmed, Wedad Madani, Bandar Knawy, National and Gulf Center for Evidence-Based Health Practice, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia.
authors: Belal
authors: B
authors: Firwana
authors: Mazen Ferwana, Imad Abdulmajeed, Ali Alhajiahmed, Wedad Madani, Bandar Knawy, National and Gulf Center for Evidence-Based Health Practice, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia.
authors: Rim
authors: R
authors: Hasan
authors: Mazen Ferwana, Imad Abdulmajeed, Ali Alhajiahmed, Wedad Madani, Bandar Knawy, National and Gulf Center for Evidence-Based Health Practice, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia.
authors: Osama
authors: O
authors: Altayar
authors: Mazen Ferwana, Imad Abdulmajeed, Ali Alhajiahmed, Wedad Madani, Bandar Knawy, National and Gulf Center for Evidence-Based Health Practice, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia.
authors: Paul J
authors: PJ
authors: Limburg
authors: Mazen Ferwana, Imad Abdulmajeed, Ali Alhajiahmed, Wedad Madani, Bandar Knawy, National and Gulf Center for Evidence-Based Health Practice, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia.
authors: Mohammad Hassan
authors: MH
authors: Murad
authors: Mazen Ferwana, Imad Abdulmajeed, Ali Alhajiahmed, Wedad Madani, Bandar Knawy, National and Gulf Center for Evidence-Based Health Practice, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia.
authors: Bandar
authors: B
authors: Knawy
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D001944:Breath Tests; D016009:Chi-Square Distribution; D004415:Dyspepsia / Q000175:diagnosis / Q000382:microbiology; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D016480:Helicobacter pylori / Q000378:metabolism*; D006801:Humans; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D014508:Urea / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D014508:Urea
keywords: Breath tests; Diagnosis; Dyspepsia; Gastritis; Helicobacter pylori; Negative predictive value; Positive predictive value; Sensitivity; Specificity; Urea/analysis
references: Med J Aust. 1989 Oct 16;151(8):435-9
references: 2593958
references: N Engl J Med. 2010 Apr 29;362(17):1597-604
references: 20427808
references: Z Gastroenterol. 2000 Jan;38(1):13-9
references: 10689743
references: Gastrointest Endosc. 2000 Jul;52(1):20-6
references: 10882957
references: Eur J Nucl Med. 1999 Jun;26(6):573-80
references: 10369942
references: J Physiol Pharmacol. 1996 Mar;47(1):79-90
references: 8777310
references: Helicobacter. 2011 Aug;16(4):327-37
references: 21762274
references: Aust N Z J Surg. 1997 Jan;67(1):31-4
references: 9033373
references: Ann Nucl Med. 2008 Aug;22(7):611-6
references: 18756364
references: Am J Gastroenterol. 1998 Nov;93(11):2082-8
references: 9820377
references: Ann Intern Med. 2011 Oct 18;155(8):529-36
references: 22007046
references: J Gastroenterol Hepatol. 2003 Nov;18(11):1237-43
references: 14535979
references: BMJ. 2003 Jan 25;326(7382):219
references: 12543843
references: Am J Gastroenterol. 1994 Jul;89(7):1027-31
references: 8017360
references: J Int Med Res. 2005 Nov-Dec;33(6):632-40
references: 16372580
references: Scand J Clin Lab Invest. 1998 Feb;58(1):19-27
references: 9516653
references: J Clin Epidemiol. 2005 Sep;58(9):882-93
references: 16085191
references: Nucl Med Rev Cent East Eur. 2002;5(1):21-4
references: 14600942
references: Dig Liver Dis. 2003 Sep;35(9):612-8
references: 14563182
references: Eur J Nucl Med Mol Imaging. 2003 Nov;30(11):1457-62
references: 14579083
references: Aten Primaria. 2003 Feb 15;31(2):93-7
references: 12609106
references: Helicobacter. 2000 Jun;5(2):98-103
references: 10849059
references: Ned Tijdschr Geneeskd. 1999 Feb 20;143(8):400-4
references: 10221110
references: Med Princ Pract. 2009;18(1):57-61
references: 19060493
references: J Clin Pathol. 1989 Jul;42(7):727-32
references: 2474579
references: Rev Esp Enferm Dig. 2007 Jul;99(7):392-7
references: 17973583
references: Sao Paulo Med J. 2002 May 2;120(3):68-71
references: 12163895
references: World J Gastroenterol. 2011 Nov 14;17(42):4682-8
references: 22180710
references: Am J Gastroenterol. 1991 Apr;86(4):438-45
references: 2012046
references: Am J Gastroenterol. 2007 Aug;102(8):1808-25
references: 17608775
references: BMC Med Res Methodol. 2006;6:31
references: 16836745
references: J Clin Epidemiol. 2006 Dec;59(12):1331-2; author reply 1332-3
references: 17098577
references: World J Gastroenterol. 2007 Feb 14;13(6):925-9
references: 17352025
references: Aliment Pharmacol Ther. 2003 Mar 15;17(6):793-8
references: 12641501
references: Clin Infect Dis. 2009 May 15;48(10):1385-91
references: 19368506
references: Scand J Gastroenterol. 1998 Jan;33(1):24-30
references: 9489904