Accuracy of the Helicobacter pylori diagnostic tests in patients with peptic ulcer bleeding: a systematic review and network meta-analysis

Introduction: Some studies suggest that the accuracy of Helicobacter pylori diagnostic tests is decreased in peptic ulcer bleeding (PUB). We aimed to assess the accuracy of diagnostic tests for H. pylori in patients with PUB in a diagnostic test accuracy (DTA) network meta-analysis. Methods: A systematic search was carried out in seven databases until November 2019. We collected or calculated true and false positive and negative values, and constructed 2×2 diagnostic contingency tables with reference standards including histology, rapid urease test, urea breath test, serology, stool antigen test, culture, and polymerase chain reaction. We ranked the index tests by the superiority indices (SI) and calculated pooled sensitivity and specificity of each test. Discussion: Our search yielded 40 eligible studies with 27 different diagnostic strategies for H. pylori. In 32 articles, the reference standard was a combination of multiple tests. In 12 studies, the index tests were compared with a single testing method. We analyzed seven networks with the reference standards against a single or a combination of diagnostic index tests. None of the index tests had better diagnostic accuracy (SI between 9.94 and 2.17) compared with the individual index tests as all the confidence intervals included 1. Combined testing strategies had higher sensitivities (0.92–0.62) and lower specificities (0.85–0.46) while single tests proved to have higher specificities (0.83–0.77) and lower sensitivities (0.73–0.42). Conclusion: Use of combined tests may have a rationale in clinical practice due to their higher sensitivities. The differences between the included DTA studies limited the comparison of the testing strategies.

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Accuracy of Diagnostic Tests for Helicobacter pylori in Patients with Peptic Ulcer Bleeding

Helicobacter ◽

10.1111/j.1523-5378.2011.00915.x ◽

2012 ◽

Vol 17 (2) ◽

pp. 77-85 ◽

Cited By ~ 27

Author(s):

Yoon J. Choi ◽

Nayoung Kim ◽

Jihwan Lim ◽

So Y. Jo ◽

Cheol M. Shin ◽

...

Keyword(s):

Helicobacter Pylori ◽

Peptic Ulcer ◽

Diagnostic Tests ◽

Ulcer Bleeding ◽

Peptic Ulcer Bleeding

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Absence of Helicobacter pylori is not protective against peptic ulcer bleeding in elderly on offending agents: lessons from an exceptionally low prevalence population

10.7287/peerj.preprints.180v1 ◽

2013 ◽

Author(s):

Yeong Yeh Lee ◽

Nordin Noridah ◽

Syed Abdul Aziz Syed Hassan ◽

Jayaram Menon

Keyword(s):

Risk Factors ◽

Helicobacter Pylori ◽

Peptic Ulcer ◽

Hospital Mortality ◽

Ulcer Bleeding ◽

Recurrent Bleeding ◽

Gi Bleeding ◽

Peptic Ulcer Bleeding ◽

H Pylori ◽

Risk For Bleeding

Aim Helicobacter pylori (H. pylori) infection is exceptionally rare in population from the north-eastern region of Peninsular Malaysia. This provides us an opportunity to contemplate the future without H. pylori in acute non-variceal upper gastrointestinal (GI) bleeding.Methods All prospective cases in the GI database registry with GI bleeding between 2003 and 2006 were reviewed. Cases with confirmed non-variceal aetiology were analysed. Rockall score > 5 was considered high risk for bleeding and primary outcomes studied were in-hospital mortality, recurrent bleeding and need for surgery. Results The incidence of non-variceal upper GI bleeding was 2.2/100,000 person-years. Peptic ulcer bleeding was the most common aetiology (1.8/100,000 person-years). In-hospital mortality (3.6%), recurrent bleeding (9.6%) and need for surgery (4.0%) were uncommon in this population with a largely low risk score (85.2% with score ≤ 5). Elderly were at greater risk for bleeding (mean 68.5 years, P = 0.01) especially in the presence of duodenal ulcers (P = 0.04) despite gastric ulcers being more common. NSAIDs (34%) and aspirin (22.8%) were the main risk factors. Conclusions The absence of H. pylori infection may not reduce the risk of peptic ulcer bleeding in the presence of risk factors especially offending drugs in the elderly.

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Absence of Helicobacter pylori is not protective against peptic ulcer bleeding in elderly on offending agents: lessons from an exceptionally low prevalence population

10.7287/peerj.preprints.180 ◽

2013 ◽

Author(s):

Yeong Yeh Lee ◽

Nordin Noridah ◽

Syed Abdul Aziz Syed Hassan ◽

Jayaram Menon

Keyword(s):

Risk Factors ◽

Helicobacter Pylori ◽

Peptic Ulcer ◽

Hospital Mortality ◽

Ulcer Bleeding ◽

Recurrent Bleeding ◽

Gi Bleeding ◽

Peptic Ulcer Bleeding ◽

H Pylori ◽

Risk For Bleeding

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Faculty Opinions recommendation of Is routine second-look endoscopy effective after endoscopic hemostasis in acute peptic ulcer bleeding? A meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717950072.793455326 ◽

2012 ◽

Author(s):

Steven Moss

Keyword(s):

Peptic Ulcer ◽

Meta Analysis ◽

Endoscopic Hemostasis ◽

Ulcer Bleeding ◽

Peptic Ulcer Bleeding ◽

Second Look

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Faculty Opinions recommendation of Effects of Helicobacter pylori infection on long-term risk of peptic ulcer bleeding in low-dose aspirin users.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717972332.793471945 ◽

2013 ◽

Author(s):

Yoshio Yamaoka ◽

Seiji Shiota

Keyword(s):

Helicobacter Pylori ◽

Peptic Ulcer ◽

Low Dose ◽

Helicobacter Pylori Infection ◽

Ulcer Bleeding ◽

Peptic Ulcer Bleeding ◽

Dose Aspirin ◽

Low Dose Aspirin

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Will Helicobacter Pylori Affect Short-Term Rebleeding Rate in Peptic Ulcer Bleeding Patients After Successful Endoscopic Therapy?

The American Journal of Gastroenterology ◽

10.1111/j.1572-0241.1999.01516.x ◽

1999 ◽

Vol 94 (11) ◽

pp. 3184-3188 ◽

Cited By ~ 11

Author(s):

Hwai-Jeng Lin ◽

Guan-Ying Tseng ◽

Yu-Hsi Hsieh ◽

Chin-Lin Perng ◽

Fa-Yauh Lee ◽

...

Keyword(s):

Helicobacter Pylori ◽

Peptic Ulcer ◽

Endoscopic Therapy ◽

Ulcer Bleeding ◽

Peptic Ulcer Bleeding ◽

Short Term ◽

Rebleeding Rate

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Helicobacter pylori Eradication within 120 Days Is Associated with Decreased Complicated Recurrent Peptic Ulcers in Peptic Ulcer Bleeding Patients

Gut and Liver ◽

10.5009/gnl13451 ◽

2015 ◽

Vol 9 (3) ◽

Cited By ~ 9

Author(s):

Shen Shong Chang ◽

Hsiao-Yun Hu

Keyword(s):

Helicobacter Pylori ◽

Peptic Ulcer ◽

Ulcer Bleeding ◽

Peptic Ulcers ◽

Peptic Ulcer Bleeding ◽

Helicobacter Pylori Eradication

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Clinical Outcomes of the Marginal Ulcer Bleeding after Gastrectomy: As Compared to the Peptic Ulcer Bleeding with Nonoperated Stomach

Gastroenterology Research and Practice ◽

10.1155/2012/624327 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Woo Chul Chung ◽

Eun Jung Jeon ◽

Kang-Moon Lee ◽

Chang Nyol Paik ◽

You Suk Oh ◽

...

Keyword(s):

Peptic Ulcer ◽

Clinical Outcomes ◽

Marginal Ulcer ◽

Ulcer Bleeding ◽

Consecutive Series ◽

Peptic Ulcer Bleeding ◽

Positive Rate ◽

Rebleeding Rate ◽

H Pylori ◽

Upper Gastrointestinal

Background. Marginal ulcer is a well-known complication after gastrectomy. Its bleeding can be severe, but the severity has rarely been reported. We aim to evaluate the clinical outcomes of marginal ulcer bleeding (MUB) as compared to peptic ulcer bleeding (PUB) with nonoperated stomach.Methods. A consecutive series of patients who had nonvariceal upper gastrointestinal bleeding and admitted to the hospital between 2005 and 2011 were retrospectively analyzed. A total of 530 patients were enrolled in this study, and we compared the clinical characteristics between 70 patients with MUB and 460 patients with PUB.Results. Patients with MUB were older (mean age:62.86±10.59years versus53.33±16.68years,P=0.01). The initial hemoglobin was lower (8.16±3.05 g/dL versus9.38±2.49 g/dL,P=0.01), and the duration of admission was longer in MUB (7.14±4.10days versus5.90±2.97days,P=0.03). After initial hemostasis, the rebleeding rate during admission was higher (16.2% versus 6.5%,P=0.01) in MUB. However, the mortality rate did not differ statistically between MUB and PUB groups.Helicobacter pylori-positive rate with MUB was lower than that of PUB (19.4% versus 54.4%,P=0.01).Conclusions. Clinically, MUB after gastrectomy is more severe than PUB with nonoperated stomach. Infection withH. pylorimight not appear to play an important role in MUB after gastrectomy.

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