Kevin Brittan, MD1, Kyle Scholten, DO1, Cindy Schmidt, MD, MLS1, Busara Songtanin, MD2, Alexandra Fiedler, MD1, Luis Zuniga, DO1, Richard Hankins, MD1, Shane Manatsathit, MD3 1University of Nebraska Medical Center, Omaha, NE; 2Texas Tech University Health Sciences Center, Lubbock, TX; 3CHI Health Creighton University Medical Center, Omaha, NE
Introduction: The use of proton pump inhibitors (PPI) have been a contraindication to obtaining stool antigen tests (SATs) for Helicobacter pylori (H. pylori). Current guidelines recommend holding PPI for two weeks prior to testing to minimize false negative rates. Recent studies have challenged the utility of holding PPIs. We performed a meta-analysis to assess SAT performance for H. pylori diagnosis on and off PPIs.
Methods: A systematic review was completed by a medical librarian (C.S.) with key keywords “stool antigen test” and “H. pylori.” Studies were included in the meta-analysis if SAT for H. pylori was conducted with an index test of a hydrogen breath test or endoscopy with histology and SATs were performed on and off PPI. Data collection was completed by two independent reviewers (K.B., K.S.). If multiple brands of SATs were performed on the same patients, the test with the highest Youden index was included for analysis. A Cochrane diagnostic meta-analysis was performed for SATs both on and off PPI. A standard correction was applied to the studies with no-event occurrences.
Results: Our systematic review found 151 studies. After secondary review, there were a total of six studies that met inclusion criteria. There were 393 patients with 247 patients with H. pylori. Off PPI, SAT performance was sensitivity 0.97 CI [0.95, 0.99], specificity 0.94 CI [0.90, 0.97], AUC 0.942. On PPI, SAT performance was sensitivity 0.82 CI [0.71, 0.92], specificity 0.92 CI [0.83, 1.00], AUC 0.817. In subgroup analysis, studies before 2004 had a significant difference in sensitivity between off PPI (sensitivity 0.96 CI [0.93,0.99]) and on PPI (sensitivity 0.72 CI [0.59,0.85]). In studies after 2004, no significant difference was found in sensitivity between off PPI subgroup (sensitivity 0.98 CI [0.95, 1.00]) and on PPI subgroup (sensitivity 0.94 [0.88,0.99]). All studies before 2004 used the same SAT kit, and all studies after 2004 used other SAT kits.
Discussion: This meta-analysis demonstrated that PPI use significantly impacted the sensitivity of previous SATs before 2004, but there was no significant difference in sensitivity of SATs after 2004 for diagnosis of H. pylori on PPI versus off PPI. There was no significant difference in specificity on or off PPI. Current guidelines recommend holding PPI for two weeks prior to testing for H. pylori with SATs to avoid false negatives. However, our findings indicate it is reasonable to perform SATs on PPI.
Figure: Figure 1 (Top Left): Sensitivity of SAT off PPI before 2004 Figure 2 (Top Right): Sensitivity of SAT on PPI before 2004 Figure 3 (Bottom Left): Sensitivity of SAT off PPI after 2004 Figure 4 (Bottom Right): Sensitivity of SAT on PPI after 2004
Disclosures:
Kevin Brittan indicated no relevant financial relationships.
Kyle Scholten indicated no relevant financial relationships.
Cindy Schmidt indicated no relevant financial relationships.
Busara Songtanin indicated no relevant financial relationships.
Alexandra Fiedler indicated no relevant financial relationships.
Luis Zuniga indicated no relevant financial relationships.
Richard Hankins indicated no relevant financial relationships.
Shane Manatsathit indicated no relevant financial relationships.
Kevin Brittan, MD1, Kyle Scholten, DO1, Cindy Schmidt, MD, MLS1, Busara Songtanin, MD2, Alexandra Fiedler, MD1, Luis Zuniga, DO1, Richard Hankins, MD1, Shane Manatsathit, MD3. P3323 - Impact of Proton Pump Inhibitor Use on Stool <i>H. pylori</i> Antigen Tests: A Cochrane Diagnostic Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
