Correia Catarina, Almeida Nuno, Figueiredo Pedro Narra
Gastroenterology Department, Coimbra University Hospital Centre, Coimbra, Portugal.
Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
GE Port J Gastroenterol. 2021 Aug 25;29(4):240-246. doi: 10.1159/000518322. eCollection 2022 Jul.
Clinical practice guidelines (CPG) contain recommendations that aim to guide physicians in the diagnosis of and therapeutic approach toward patients affected by gastrointestinal (GI) pathologies. These CPG systematically combine scientific evidence and clinical judgment, culminating in recommendations that have been shown to improve patient care.
European and North American guidelines published in the area of gastroenterology in 2018 and 2019 were considered for inclusion. To standardize the results, only guidelines that used GRADE as an evidence system were included. Thus, in the end, 1,233 recommendations from 29 guidelines published between 2018 and 2019 were analyzed.
Of the 1,233 recommendations collected, 324 (26.3%) had a low level of evidence and 127 (10.3%) had a very low level of evidence, indicating little evidence or expert opinion. Of the 29 publications analyzed, 14 (48.3%) did not present any recommendation with a high level of evidence. Regarding the 1,233 individual recommendations expressed in these 29 publications, only 336 (27.25%) assumed a high level of evidence, with 277 (82.44%) referring to liver pathology. Of the recommendations evaluated, 77 were from North American societies and the remaining 1,156 were European recommendations. In relation to the first group, only 3 (3.9%) had a high level of evidence belonging to the Guidelines for Sedation and Anesthesia in GI Endoscopy.
More than 25% of all recommendations currently accepted to guide patients with gastroenterological disorders are based on low-quality evidence or expert opinion. Thus, these documents should guide our performance, but clinical sense and multidisciplinarity must not be overlooked in dubious cases and with weak scientific evidence. Research should focus on the development of randomized controlled trials and systematic reviews to improve the evidence supporting the guidelines that guide clinical practice.
临床实践指南（CPG）包含旨在指导医生对胃肠道（GI）疾病患者进行诊断和治疗的建议。这些CPG系统地结合了科学证据和临床判断，最终形成已被证明可改善患者护理的建议。
纳入2018年和2019年发表在胃肠病学领域的欧洲和北美指南。为使结果标准化，仅纳入使用GRADE作为证据系统的指南。因此，最终分析了2018年至2019年发表的29份指南中的1233条建议。
在收集的1233条建议中，324条（26.3%）证据水平低，127条（10.3%）证据水平极低，表明证据或专家意见很少。在分析的29份出版物中，14份（48.3%）未提出任何高水平证据的建议。关于这29份出版物中表达的1233条个人建议，只有336条（27.25%）具有高水平证据，其中277条（82.44%）涉及肝脏病理学。在评估的建议中，77条来自北美协会，其余1156条是欧洲建议。对于第一组，只有3条（3.9%）具有高水平证据，属于胃肠内镜检查镇静和麻醉指南。
目前被接受用于指导胃肠病患者的所有建议中，超过25%基于低质量证据或专家意见。因此，这些文件应指导我们的工作，但在可疑病例和科学证据薄弱的情况下，临床意识和多学科性绝不能被忽视。研究应侧重于开展随机对照试验和系统评价，以改善支持指导临床实践的指南的证据。
