***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND & AIMS The guidelines of the European Society of Pediatric Gastroenterology , Hepatology , and Nutrition allow for diagnosis of celiac disease without biopsies in children with symptoms and levels of immunoglobulin A against tissue-transglutaminase ( TGA-IgA ) 10-fold or more the upper limit of normal ( ULN ) , confirmed by detection of endomysium antibodies ( EMA ) and positivity for HLA-DQ2/DQ8 . We performed a large , international prospect i ve study to vali date this approach . METHODS We collected data from consecutive pediatric patients ( 18 years or younger ) on a gluten-containing diet who tested positive for TGA-IgA from November 2011 through May 2014 , seen at 33 pediatric gastroenterology units in 21 countries . Local centers recorded symptoms ; measurements of total IgA , TGA , and EMA ; and histopathology findings from duodenal biopsies .  Children were considered to have malabsorption if they had chronic diarrhea , weight loss ( or insufficient gain ) , growth failure , or anemia . We directly compared central findings from 16 antibody tests ( 8 for TGA-IgA , 1 for TGA-IgG , 6 for IgG against deami date d gliadin peptides , and 1 for EMA , from 5 different manufacturers ) , 2 HLA-DQ2/DQ8 tests from 2 manufacturers , and histopathology findings from the reference pathologist . Final diagnoses were based on local and central results . If all local and central results were concordant for celiac disease , cases were classified as proven celiac disease . Patients with only a low level of TGA-IgA ( threefold or less the ULN ) but no other results indicating celiac disease were classified as no celiac disease . Central histo-morphometry analyses were performed on all other biopsies and cases were carefully review ed in a blinded manner . Inconclusive cases were regarded as not having celiac disease for calculation of diagnostic accuracy . The primary aim was to determine whether the nonbiopsy approach identifies children with celiac disease with a positive predictive value ( PPV ) above 99 % in clinical practice . Secondary aims included comparing performance of different serological tests and to determine whether the suggested criteria can be simplified . RESULTS Of 803 children recruited for the study , 96 were excluded due to incomplete data , low level of IgA , or poor- quality biopsies . In the remaining 707 children ( 65.1 % girls ; median age , 6.2 years ) , 645 were diagnosed with celiac disease , 46 were found not to have celiac disease , and 16 had inconclusive results . Findings from local laboratories of TGA-IgA 10-fold or more the ULN , a positive result from the test for EMA , and any symptom identified children with celiac disease ( n = 399 ) with a PPV of 99.75 ( 95 % confidence interval [ CI ] , 98.61 - 99.99 ) ; the PPV was 100.00 ( 95 % CI , 98.68 - 100.00 ) when only malabsorption symptoms were used instead of any symptom ( n = 278 ) . Inclusion of HLA analyses did not increase accuracy . Findings from central laboratories differed greatly for patients with lower levels of antibodies , but when levels of TGA-IgA were 10-fold or more the ULN , PPVs ranged from 99.63 ( 95 % CI , 98.67 - 99.96 ) to 100.00 ( 95 % CI , 99.23 - 100.00 ) . CONCLUSIONS Children can be accurately diagnosed with celiac disease without biopsy analysis . Diagnosis based on level of TGA-IgA 10-fold or more the ULN , a positive result from the EMA tests in a second blood sample , and the presence of at least 1 symptom could avoid risks and costs of endoscopy for more than half the children with celiac disease worldwide . HLA analysis is not required for accurate diagnosis . Clinical Trial Registration no : DRKS00003555 Background We aim ed at assessing the factors that can influence results of the dissemination of an already vali date d , new generation commercial Point-of-Care Test ( POCT ) for detecting celiac disease ( CD ) , in the Mediterranean area , when used in setting s where it was design ed to be administered , especially in countries with poor re sources . Methods Pragmatic study design . Family pediatricians at their offices in Italy , nurses and pediatricians in Slovenia and Turkey at pediatricians ’ , schools and university primary care centers looked for CD in 3,559 ( 1 - 14 yrs ) , 1,480 ( 14 - 23 yrs ) and 771 ( 1 - 18 yrs ) asymptomatic subjects , respectively . A new generation POCT detecting IgA-tissue antitransglutaminase antibodies and IgA deficiency in a finger-tip blood drop was used . Subjects who tested positive and those suspected of having CD were referred to a Celiac Centre to undergo further investigations in order to confirm CD diagnosis . POCT Positive Predictive Value ( PPV ) at tertiary care ( with Negative Predictive Value ) and in primary care setting s , and POCT and CD rates per thous and in primary care were estimated . Results At tertiary care setting , PPV of the POCT and 95 % CI were 89.5 ( 81.3 - 94.3 ) and 90 ( 56 - 98.5 ) with Negative Predictive Value 98.5 ( 94.2 - 99.6 ) and 98.7 % ( 92 - 99.8 ) in children and adults , respectively . In primary care setting s of different countries where POCT was performed by a different number of personnel , PPV ranged from 16 to 33 % and the CD and POCT rates per thous and ranged from 4.77 to 1.3 and from 31.18 to 2.59 , respectively . Conclusions Interpretation of POCT results by different personnel may influence the performance of POC but dissemination of POCT is an urgent priority to be implemented among people of countries with limited re sources , such as rural population s and school children BACKGROUND / AIMS Celiac disease has a large prevalence worldwide . There are a limited number of comparable epidemiological data for celiac disease in Turkey . The aim of this preliminary study was to determine the prevalence of celiac disease in a sample of 1000 Turkish children by a novel , simple , and visual one-step immunoassay screening test . METHODS This prospect i ve study consisted of 1000 serum sample s from apparently healthy children and children with disorders other than celiac disease aged between 2 - 18 years who presented as out patients at Ankara University , Faculty of Medicine , Department of Pediatrics . Sera were tested for IgA-class antibodies against human tissue transglutaminase and gliadin by rapid immunochromatographic line immunoassay .  Endomysial antibody IgA against human tissue transglutaminase and AGA IgA/IgG were also tested by ELISA as a second step when the result of the screening test was positive . Small bowel biopsy was recommended to all the children with positive anti-tissue transglutaminase and /or endomysial antibody results . RESULTS Ten of the 1000 individuals ( 1 % ) had positive antibody screening test to human tissue transglutaminase . All tissue transglutaminase-positive sample s revealed good correlation with endomysial antibody by ELISA method . Subsequently small bowel biopsy was performed in all serology-positive cases . Biopsy results confirmed a diagnosis of celiac disease in nine cases . The prevalence of biopsy- proven celiac disease was 1:111 ( 0.9 % ) . CONCLUSIONS Determination of anti-tissue transglutaminase antibodies by simple visual system for celiac disease appeared to be as reliable as the ELISA system . It is easy to perform and interpret , cost-effective , and rapid , as pointed out in other previous studies , as a screening test in large population -based studies . The prevalence of celiac disease in the overall sample of Turkish children ( 1:111 or 0.9 % ) in this preliminary study is similar to that reported in European and Middle Eastern countries and the United States Background Celiac disease may emerge at any age , but little is known of its appearance in elderly people . We evaluated the prevalence of the condition in individuals over 55 years of age , and determined the incidence of biopsy-proven celiac disease ( CDb ) and celiac disease including seropositive subjects for anti-tissue transglutaminase antibodies ( CDb+s ) . Methods The study based on prevalence figures in 2815 r and omly selected subjects who had undergone a clinical examination and serologic screening for celiac disease in 2002 . A second screening in the same population was carried out in 2005 , comprising now 2216 individuals . Positive tissue transglutaminase antibodies were confirmed with small bowel biopsy . Results Within three years the prevalence of CDb increased from 2.13 to 2.34 % , and that of CDb+s from 2.45 to 2.70 % . Five new cases were found among patients previously seronegative ; two had minor abdominal symptoms and three were asymptomatic . The incidence of celiac disease in 2002–2005 was 0.23 % , giving an annual incidence of 0.08 % in this population . Conclusion The prevalence of celiac disease was high in elderly people , but the symptoms were subtle . Repeated screening detected five biopsy-proven cases in three years , indicating that the disorder may develop even in the elderly . Increased alertness to the disorder is therefore warranted Abstract Objective . The anti-transglutaminase antibodies ( anti-tTG ) play an important role in monitoring the celiacs ' gluten-free diet ( GFD ) . Material and methods . The authors propose to use the rapid IgA anti-tTG assay based on a whole blood drop to evaluate the compliance to GFD at the clinical ambulatory setting . The rapid test results were compared with those of the conventional ELISA assay and with dietary compliance reported by patients ' interview . Conclusions . The authors showed that anti-tTG rapid test is reliable and easy to perform in the ambulatory setting to evaluate dietary compliance . Moreover , they proved that celiacs ' interview is more sensitive than serology in identifying patients who transgress Background International guidelines recommend coeliac serology in iron deficiency anaemia , and duodenal biopsy for those tested positive to detect coeliac disease . However , pre-endoscopy serology is often unavailable , thus committing endoscopists to take routine duodenal biopsies . Some endoscopists consider duodenal biopsy m and atory in anaemia to exclude other pathologies . We hypothesise that using a point of care test at endoscopy could fill this gap , by providing rapid results to target anaemic patients who require biopsies , and save costs by biopsy avoidance . We therefore assessed three key aspects to this hypothesis : 1 ) the availability of pre-endoscopy serology in anaemia ; 2 ) the sensitivities and cost effectiveness of pre-endoscopy coeliac screening with Simtomax in anaemia ; 3 ) whether other anaemia-related pathologies could be missed by this targeted-biopsy approach . Methods Group 1 : pre-endoscopy serology availability was retrospectively analysed in a multicentre cohort of 934 anaemic patients at 4 UK hospitals . Group 2 : the sensitivities of Simtomax , endomysial and tissue-transglutaminase antibodies  were compared in 133 prospect ively recruited patients with iron deficiency anaemia attending for a gastroscopy . The sensitivities were measured against duodenal histology as the reference st and ard in all patients . The cost effectiveness of Simtomax was calculated based on the number of biopsies that could have been avoided compared to an all-biopsy approach . Group 3 : the duodenal histology of 153 patients presenting to a separate iron deficiency anaemia clinic were retrospectively review ed . Results In group 1 , serology was available in 361 ( 33.8 % ) patients . In group 2 , the sensitivity and negative predictive value ( NPV ) were 100 % and 100 % for Simtomax , 96.2 % and 98.9 % for IgA-TTG , and 84.6 % and 96.4 % for EMA respectively . In group 3 , the duodenal histology found no causes for anaemia other than coeliac disease . ConclusionS imtomax had excellent diagnostic accuracy in iron deficiency anaemia and was comparable to conventional serology . Duodenal biopsy did not identify any causes other than coeliac disease for iron deficiency anaemia , suggesting that biopsy avoidance in Simtomax negative anaemic patients is unlikely to miss other anaemia-related pathologies . Due to its 100 % NPV , Simtomax could reduce unnecessary biopsies by 66 % if only those with a positive Simtomax were biopsied , potentially saving £ 3690/100 gastroscopies . Trial registration The group 2 study was retrospectively registered with clinical trials.gov . Trial registration date : 13th July 2016 ; Trial registration number : NCT02834429 Objective : Diagnostic criteria for coeliac disease ( CD ) from the European Society for Paediatric Gastroenterology , Hepatology , and Nutrition ( ESPGH 
    Output:
    
Conclusions : The pooled sensitivity and specificity of POCTs in diagnosing CD are high .
POCTs may be used to screen for CD , especially in areas with limited access to laboratory-based testing .