The practice guidelines published by the American Gastroenterological Association (AGA) and the American College of Gastroenterology (ACG) are used to establish standards of care and improve patient outcomes.
Dr Joseph Feuerstein and colleagues from Massachussetts, USA examined the guidelines for quality of evidence, methods of grading evidence, and conflicts of interest.
The research team reviewed all 81 guidelines available online in 2012 for the presence of grading of evidence and conflicts of interest.
The team evaluated 570 recommendations for level of evidence and methods used to grade the evidence.
The data were evaluated in aggregate and by society.
|87% of the ACG guidelines graded the evidence|
|American Journal of Gastroenterology|
Only 31% of the guidelines graded the levels of evidence.
A total of 12 systems were used to grade the quality of evidence in these 25 guidelines.
Of the 570 recommendations reviewed, the team found that only 29% were supported by the highest quality of evidence, level A, 37% by level B, 29% by level C, and 5% by level D.
Since 2007, the team found that 87% of the ACG guidelines graded the evidence compared with only 33% of the AGA guidelines.
Furthermore, 70% of the guidelines failed to disclose any information regarding conflicts of interest.
Of the 24 articles commenting on conflicts of interest, 67% reported conflicts of interest.
Dr Feuerstein's team concludes, "Although the majority of the gastroenterology guidelines fail to grade the quality of evidence, more recent ACG guidelines grade majority of their recommendations."
"When the evidence is graded, most of the supporting evidence is based on lower-quality evidence."
"In addition, most of the guidelines fail to comment on conflicts of interest, and when disclosed, numerous conflicts of interest were present."
"This study highlights the critical need to revise the guideline development process."
"Future guidelines should clearly state the quality of evidence for their recommendations, utilize a standard grading system, and be transparent regarding all conflicts of interest."