Accuracy of urea breath test in Helicobacter pylori infection: Meta-analysis

Mazen Ferwana, Imad Abdulmajeed, Ali Alhajiahmed, Wedad Madani, Belal Firwana, Rim Hasan, Osama Altayar, Paul J. Limburg, Mohammad Hassan Murad, Bandar Knawy

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158 Scopus citations


AIM: 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. CONCLUSION: 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.

Original languageEnglish
Pages (from-to)1305-1314
Number of pages10
JournalWorld Journal of Gastroenterology
Issue number4
StatePublished - Jan 28 2015


  • Breath tests
  • Diagnosis
  • Dyspepsia
  • Gastritis
  • Helicobacter pylori
  • Negative predictive value
  • Positive predictive value
  • Sensitivity
  • Specificity
  • Urea/analysis


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