Abstract
The increasing prevalence of clarithromycin (CLA)-resistant Helicobacter pylori (H. pylori) strains poses a significant challenge in the management of H. pylori infections. This systematic review and meta-analysis investigates the diagnostic accuracy of Polymerase Chain Reaction (PCR) in identifying CLA-resistant H. pylori strains in stool. A comprehensive literature search was conducted using PubMed, EMBASE, and Cochrane databases from database inception to April 30, 2023. Eligible studies evaluated the effectiveness of PCR stool tests in detecting CLA-resistant H. pylori strains in adults (>18 years old). Studies of pediatric populations, alternative methods to PCR or stool samples, and reference tests other than gastric biopsy were excluded. The bivariate random-effects model was employed to pool diagnostic accuracy from the included studies. The analysis of eleven prospective diagnostic studies with a total of 866 patients showed a pooled sensitivity of 0.97 (95% CI: 0.9-0.99) and a pooled specificity of 0.98 (95% CI: 0.81-1.00). Subgroup analysis based on the employed technique demonstrated consistent findings without notable variations. The Diagnostic Odds Ratio (DOR) was calculated at 1843.92 (95% CI: 134.28 - 25321.3). The Positive Likelihood Ratio (+LR) was determined as 51.02 (95% CI: 4.61 - 564.5), while the Negative Likelihood Ratio (-LR) was found to be 0.03 (95% CI: 0.01- 0.1). PCR testing for clarithromycin-resistant H. pylori was highly sensitive and specific across studies with proven reliability in clinical practice, particularly in outpatient settings. Their implementation offers cost-effectiveness and the potential for tailored treatment strategies, holding promise for improved patient outcomes.
Published Version
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