Unveiling the Power of Molecular Testing in Detecting Clarithromycin-Resistant Helicobacter pylori in Stool: A Systematic Review and Meta-Analysis

Introduction: The increasing prevalence of clarithromycin (CLA)-resistant H. pylori strains poses a significant challenge in the management of H. pylori infections. This meta-analysis investigates the diagnostic accuracy of molecular testing methods for identifying CLA-resistant H. pylori strains in stool. Methods: A systematic search was conducted in PubMed, Ovid, EMBASE, and Cochrane databases up to April 2023. It aimed to identify full-text studies evaluating the efficacy of molecular stool tests in detecting CLA-resistant H. pylori. Inclusion criteria specified the adult population (>18 years old), molecular stool testing for CLA resistance, and comparison with antibiotic susceptibility or PCR on gastric biopsy. Studies involving pediatric populations, alternative methods to PCR or stool samples, and reference tests other than gastric biopsy were excluded. The bivariate model was employed to analyze the diagnostic accuracy data and estimate summary measures. Results: The initial search yielded a total of 1832 studies, from which 121 relevant articles were selected based on title and abstract review. Eleven studies met the inclusion criteria. A total of 866 patients were included in the analysis. In all studies, except 2, a culture of the gastric biopsy served as the gold standard, while PCR on the biopsy was used in the remaining 2. Table 1 provides detailed characteristics of each study. The analysis of sensitivity and specificity values revealed a sensitivity range of 0.73 to 1.0, with a pooled estimate of 0.97 (95% CI: 0.9-0.99, I2 = 15.52). The specificity ranged from 0 to 1.0, with a pooled estimate of 0.98 (95% CI: 0.81-1.0, I2 = 1.48). The observed heterogeneity between studies was minimal. The forest plot and the summary of receiver operator curve are detailed in Figure 1. Conclusion: Our meta-analysis provides strong evidence for the effectiveness of molecular testing methods in accurately detecting clarithromycin-resistant H. pylori strains in stool samples. The high sensitivity and specificity observed across the studies support their reliability in clinical practice, particularly in outpatient settings, where invasive procedures can be minimized. Additionally, the implementation of these methods can have notable cost-effectiveness implications. In summary, our findings highlight the promise of molecular testing for identifying clarithromycin resistance in H. pylori, offering opportunities for tailored treatment strategies and improved patient outcomes.Figure 1.: The forest plot and the summary of receiver operator curve.