Is there a standardized practice for the development of international ulcerative colitis and Crohn's disease treatment guidelines?

Alexander Goldowsky; Rohan Sen; Gila Hoffman; Joseph D Feuerstein

doi:10.1093/gastro/goab009

Is there a standardized practice for the development of international ulcerative colitis and Crohn's disease treatment guidelines?

Gastroenterol Rep (Oxf). 2021 Mar 29;9(5):408-417. doi: 10.1093/gastro/goab009. eCollection 2021 Oct.

Authors

Alexander Goldowsky¹, Rohan Sen¹, Gila Hoffman¹, Joseph D Feuerstein²

Affiliations

¹ Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
² Department of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Abstract

Background: Guidelines are published by international gastroenterology societies regarding the management of ulcerative colitis (UC) and Crohn's disease (CD) to help clinicians to provide high-quality patient care. We examined the guidelines for the quality and strength of evidence used to develop the recommendations, methods for grading evidence, differences in disease-specific recommendations, conflicts of interest, and plans for guideline updates.

Methods: A systematic search was performed on PubMed using "ulcerative colitis," "Crohn's disease," and "guidelines" in April 2019. International gastroenterology society websites were searched for UC- and CD-specific guidelines. Guidelines from 12 societies were examined by two authors. Chi-squared tests were used for comparing evidence-level grades, strength of recommendations, and reported conflicts of interest. Linear-regression modeling was used to evaluate the relationship between the number of authors and the number of recommendations in a given guideline.

Results: Of 28 guidelines reviewed, 25 (89%) used a total of three different systems to grade the level of evidence and 2 (7%) used an unknown system. Three (11%) reviewed guidelines did not provide a conflict-of-interest statement, while three (11%) provided a timeline for guideline updates. Of 1,265 total statements examined, 246 (19%) reported no grade of evidence quality or explicitly stated that the recommendation was based on "expert opinion." One hundred and thirty-five (22%) UC recommendations were noted to be "weak/conditional" and 95 (16%) did not have a recommendation strength. Two hundred and forty-two (37%) CD recommendations were noted to be "weak/conditional" and 151 (23%) did not have a recommendation strength.

Conclusion: The majority of UC and CD guidelines are based on a low/very low quality of evidence and are further weakened due to the lack of homogeneity in specific aspects of management recommendations as well as conflicts of interest.

Keywords: Crohn’s disease; conflicts of interest; guidelines; inflammatory bowel disease; ulcerative colitis.