Twenty-three studies were included in the review.

All of the meta-analyses showed evidence of statistical heterogeneity.

Rapid urease test (16 studies, n=1,417).

The sensitivity ranged from 0.41 to 0.94 and the specificity from 0.78 to 1.00. The pooled sensitivity was 0.67 (95% CI: 0.64, 0.70; I-squared 89%) and the pooled specificity 0.93 (95% CI: 0.90, 0.96; I-squared 70%). The pooled positive and negative LRs were 9.6 (95% CI: 5.1, 18.1; p=0.05) and 0.31 (95% CI: 0.22, 0.44; p<0.001), respectively.

Histology (10 studies, n=827).

The sensitivity ranged from 0.33 to 0.98 and the specificity from 0.45 to 1.00; mean prevalence was 80% (range: 59 to 100%). The pooled sensitivity was 0.70 (95% CI: 0.66, 0.74; I-squared 93%) and the pooled specificity 0.90 (95% CI: 0.85, 0.94; I-squared 81%). The pooled positive and negative LRs were 6.7 (95% CI: 2.5, 18.4; p=0.05) and 0.23 (95% CI: 0.12, 0.46; p<0.001), respectively. The subgroup analysis showed that heterogeneity was reduced when only samples obtained from both the antrum and corpus were considered.

Culture and other biopsy-based methods (3 studies, n=314).

The sensitivity ranged from 0.34 to 0.88 and the specificity from 0.98 to 1.00 (2 studies); mean prevalence was 79% (range: 71 to 100%). The pooled sensitivity was 0.45 (95% CI: 0.39, 0.51; I-squared 95%) and the pooled specificity 0.98 (95% CI: 0.92, 1.00; p=0.52). The pooled positive and negative LRs were 19.6 (95% CI: 4, 96; p=0.89) and 0.31 (95% CI: 0.05, 1.9; p<0.001), respectively.

Urea breath test (8 studies, n=520).

The sensitivity ranged from 0.86 to 1.00 and the specificity from 0.78 to 1.00; mean prevalence was 70% (range: 32 to 100%). The pooled sensitivity was 0.93 (95% CI: 0.90, 0.95; I-squared 44%) and the pooled specificity 0.92 (95% CI: 0.87, 0.96; I-squared 68%). The pooled positive and negative LRs were 9.5 (95% CI: 3.9, 23.3; p=0.05) and 0.11 (95% CI: 0.07, 0.16; p=0.46), respectively.

Stool antigen test (6 studies, n=377).

The sensitivity ranged from 0.74 to 1.00 and the specificity from 0.33 to 0.90; mean prevalence was 63% (range: 42 to 100%). The pooled sensitivity was 0.87 (95% CI: 0.82, 0.91; I-squared 73%) and the pooled specificity 0.70 (95% CI: 0.62, 0.78; I-squared 85%). The pooled positive and negative LRs were 2.3 (95% CI: 1.4, 4; p<0.001) and 0.2 (95% CI: 0.13, 0.3; p=0.63), respectively.

Serology (9 studies, n=803).

The sensitivity ranged from 0.68 to 1.00 and the specificity from 0.11 to 0.84; mean prevalence was 72% (range: 46 to 100%). The pooled sensitivity was 0.88 (95% CI: 0.85, 0.90; I-squared 79%) and the pooled specificity 0.69 (95% CI: 0.62, 0.75; I-squared 77%). The pooled positive and negative LRs were 2.5 (95% CI: 1.6, 4.1; p<0.001) and 0.25 (95% CI: 0.19, 0.33; p=0.32), respectively.