Accuracy of testing for anti- Helicobacter pylori IgG in urine for H. pylori infection diagnosis: a systematic review and meta-analysis

Abstract

Objectives: This meta-analysis aims to systematically measure the potential diagnostic value of anti-Helicobacter pylori IgG in urine for infection diagnosis, using all eligible studies published in English and Chinese languages.

Design: The random effect model was used to analyse the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative LR (NLR), diagnostic OR (DOR), together with the summary receiver operator characteristic curve.

Setting: Literature searches of databases including PubMed, EMBASE, MEDLINE, Web of Science, Chinese National Knowledge Infrastructure and Wanfang databases were performed to retrieve studies evaluating the diagnostic value of urine IgG antibody for H.pylori infection.

Primary outcome measure: Twenty-three studies with 4963 subjects were included in the current meta-analysis.

Results: The pooled sensitivity, specificity, PLR, NLR, DOR and area under the curve (AUC) were 0.83 (95% CI 0.82 to 0.85), 0.89 (95% CI 0.88 to 0.90), 8.81 (95% CI 6.37 to 12.2), 0.13 (95% CI 0.09 to 0.2), 73 (95% CI 46.45 to 114.74) and 0.9551, respectively. Subgroup analyses showed that diagnostic accuracy of the urine IgG assay was no different in age, region, study population and assay method.

Conclusions: Anti-H. pylori antibody in urine might serve as a good marker in diagnosing H. pylori infection. However, further validation based on a larger sample is still required.

Keywords: H.pylori; Meta analysis; diagnosis; urine IgG antibody.

Figure 1

Flow diagram of the literature search. CNKI, Chinese National Knowledge Infrastructure; HpSA, Helicobacter pylori stool antigen test; UBT, urea breath test.

Figure 2

Forest plots of diagnostic OR (DOR) for Helicobacter pylori diagnosis by urine IgG antibody. The pooled DOR was 73 (95% CI 46.45 to 114.74).

Figure 3

Forest plots of sensitivity, specificity, PLR and NLR for H. pylori diagnosis by urine IgG antibody. (A) The summary sensitivity was 0.83 (95% CI 0.82 to 0.85; I²=94.4%). (B) The summary specificity was 0.89 (95% CI 0.87 to 0.90; I²=86.1%). (C) The summary PLR was 8.5 (95% CI 6.27 to 12.2; I²=81.0%). (D) The summary NLR of all articles was 0.13 (95% CI 0.09 to 0.20; I²=96.3%). NLR, negative likelihood ratio; PLR, positive likelihood ratio.