Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2021; 9(1): 133-147
Published online Jan 6, 2021. doi: 10.12998/wjcc.v9.i1.133
Polymerase chain reaction-based tests for detecting Helicobacter pylori clarithromycin resistance in stool samples: A meta-analysis
Ren-Jie Gong, Can-Xia Xu, Huan Li, Xiao-Ming Liu
Ren-Jie Gong, Can-Xia Xu, Huan Li, Xiao-Ming Liu, Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
Author contributions: Gong RJ conceived and designed the study, acquired, analyzed and interpreted the data, and drafted and revised the article; Xu CX acquired, analyzed, and interpreted the data and revised the article; Li H acquired, analyzed, and interpreted the data; Liu XM interpreted the data, critically revised the article, and approved the final version.
Supported by “New Xiangya Talent Projects” of The Third Xiangya Hospital of Central South University, No. JY201710.
Conflict-of-interest statement: The authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Ming Liu, MD, Chief Doctor, Department of Gastroenterology, The Third Xiangya Hospital of Central South University, No. 138 Tongzipo Street, Changsha 410013, Hunan Province, China. liuxiaoming26@163.com
Received: August 6, 2020
Peer-review started: August 6, 2020
First decision: November 3, 2020
Revised: November 7, 2020
Accepted: November 14, 2020
Article in press: November 14, 2020
Published online: January 6, 2021
Abstract
BACKGROUND

Helicobacter pylori (H. pylori) infection is closely associated with the etiology of a variety of gastric diseases. The effective eradication of H. pylori infection has been shown to reduce the incidence of gastric carcinoma. However, the rate of H. pylori eradication has significantly declined due to its increasing resistance to antibiotics, especially to clarithromycin. Therefore, the detection of clarithromycin resistance is necessary prior to the treatment of H. pylori. Although many studies have been conducted on the use of polymerase chain reaction (PCR)-based tests to detect clarithromycin resistance in stool samples, no accurate data on the feasibility of these tests are available. Here, we performed a meta-analysis to assess the feasibility of these noninvasive tests.

AIM

To evaluate the reliability of PCR-based tests for detecting H. pylori clarithromycin resistance in stool samples.

METHODS

We searched PubMed, Medline, Embase, and other databases for articles that evaluated the value of the PCR analysis of stool samples for detecting the resistance of H. pylori to clarithromycin. We collected cross-sectional studies that met the inclusion criteria. Diagnostic accuracy measures were pooled using a random-effects model. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Subgroup analysis was also conducted according to PCR type, purification technique, reference standard, mutation site, sample weight, number of patients, and age group, and the clinical utility of diagnostic tests was evaluated using the Likelihood Ratio Scatter Graph.

RESULTS

Out of the 1818 identified studies, only 11 met the eligibility criteria, with a total of 592 patients assessed. A meta-analysis of the random-effect model showed that PCR-based analysis of stool samples had high diagnostic accuracy for detecting clarithromycin resistance in patients infected with H. pylori. The combined sensitivity was 0.91 [95% confidence interval (CI): 0.83-0.95], Q = 30.34, and I2 = 67.04, and the combined specificity was 0.97 (95%CI: 0.62-1.00), Q = 279.54, and I2 = 96.42. The likelihood ratio for a positive test was 33.25 (95%CI: 1.69-652.77), and that for a negative test was 0.10 (95%CI: 0.05-0.18), with an area under the curve of 0.94. The diagnostic odds ratio was 347.68 (95%CI: 17.29-6991.26). There was significant statistical heterogeneity, and the sub-analyses showed significant differences in the number of patients, sample weight, purification methods, PCR types, mutation points, and reference standards. The included studies showed no risk of publication bias.

CONCLUSION

PCR-based tests on stool samples have high diagnostic accuracy for detecting H. pylori clarithromycin resistance.

Keywords: Helicobacter pylori, Clarithromycin resistance, Polymerase chain reaction, Feces, Meta-analysis

Core Tip: No consensus is available in the literature about the reliability of polymerase chain reaction (PCR)-based tests for detecting Helicobacter pylori (H. pylori) clarithromycin resistance in stool samples. This is the first meta-analysis deciphering these methods based on the numbers of true-positive, false-positive, false-negative, and true-negative test results. Our results show that PCR-based approaches on stool samples have high diagnostic accuracy for detecting H. pylori clarithromycin resistance.