Assessment of Evidence Quality in Inflammatory Bowel Disease Guidance: The Use and Misuse of GRADE

Abstract

A core principle of evidence based medicine is that optimal clinical care must be grounded in systematic summaries of the best available evidence. Over 40 years, the methodology of systematic reviews has evolved sophisticated approaches to framing study questions, conducting comprehensive searches, evaluating risk of bias, and most recently and perhaps most crucially making judgements of the quality (also referred to as confidence or certainty) of the evidence. More recently – largely in the last 20 years – methodologists have developed and applied scientific standards to the process of moving from evidence to recommendations; that is, the process of creating clinical practice guidelines.
In this article, we will discuss this evolution in the particular context of inflammatory bowel disease. Although clinical leaders and stakeholder organisations within gastroenterology have embraced scientific standards for systematic reviews and guidelines, problematic practices that risk undermining the evidence based credentials of guidelines and undoing the progress made over the last decades still remain.