Background: Helicobacter pylori (H. pylori) infection is known to be associated with peptic ulcer and gastric cancer. Detection of H. pylori infection is a significant part of peptic ulcer and gastric cancer prevention and management. 13C-urea breath test (UBT) provides a good option for the pathogen detection due to its accuracy and safety.
Objective: This review aims to evaluate the 13C-UBT diagnostic accuracy studies conducted among Asian population and validate its use for the Asian population.
Methods: Original articles were systematically searched in PubMed, Scopus, and Google Scholar using the PICOS strategy by applying relevant keywords. Only studies published in English and conducted in Asia were included. Our search returned 276 articles. After assessment, 11 articles which answered our research question and met the criteria set for systematic review and meta-analysis were accepted. A total of 15 study protocols were extracted from the 11 accepted articles.
Findings: Majority of the studies were conducted in Hong Kong (six), followed by Taiwan (five), Japan (two), and one each in Singapore and Israel. All studies had used histology as part of its gold standard of reference. All but one study was performed on adult populations. The summary estimate for sensitivity was 97% (95% CI: 96, 98%), and specificity was 96% (95% CI: 95, 97%), with significant heterogeneity between studies. Adjusting for the dose (50 mg) and breath sample collection time (20 minutes) had improved both accuracy estimates and significantly reduced heterogeneity.
Conclusion: This review supports the test-and-treat strategy for H. pylori infection management. Prevalence and cost-effectiveness studies are mandatory for health authorities to adopt this strategy into national policy.
© 2019 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.
Conflict of interest statement
The authors have no competing interests to declare.
Non-invasive Diagnostic Tests for Helicobacter Pylori InfectionLM Best et al. Cochrane Database Syst Rev 3 (3), CD012080. PMID 29543326. - ReviewIn people without a history of gastrectomy and those who have not recently had antibiotics or proton ,pump inhibitors, urea breath tests had high diagnostic accuracy whil …
Efficacy and Cost-Effectiveness of the 13C-urea Breath Test as the Primary Diagnostic Investigation for the Detection of Helicobacter Pylori Infection Compared to Invasive and Non-Invasive Diagnostic TestsM Nocon et al. GMS Health Technol Assess 5, Doc14. PMID 21289901.Based on available medical and economic studies, there is no sufficient evidence to recommend test and-treat using (13)C-urea breath testing for the detection of H. pylor …
The Accuracy of the Rapid Urease Test and 13C-urea Breath Test in the Diagnosis of Helicobacter Pylori InfectionAS Ho et al. Zhonghua Yi Xue Za Zhi (Taipei) 58 (6), 400-6. PMID 9068206.Both the CLO and 13C-UBT had higher accuracy in the detection of H. pylori. When the CLO test result is positive, there is little additional diagnostic benefit from perfo …
Validation of 13C-urea Breathtest for the Diagnosis of Helicobacter Pylori Infection in the Singapore PopulationTS Chua et al. Singapore Med J 43 (8), 408-11. PMID 12507026. - Clinical TrialThe 13C-UBT is a simple, safe, and accurate non-invasive test for the detection of H. pylori infection, making it a valuable tool in local clinical practice.
Accuracy of Urea Breath Test in Helicobacter Pylori Infection: Meta-AnalysisM Ferwana et al. World J Gastroenterol 21 (4), 1305-14. PMID 25632206. - ReviewUBT has high diagnostic accuracy for detecting H. pylori infection in patients with dyspepsia. The reliability of diagnostic meta-analytic estimates however is limited by …
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