Gastroenterology Guidelines Transparency: A Call for Improvement in the United States and Europe

Introduction: Transparency is a key factor to minimize potential biases such as expert or industrial influences in Clinical Practice Guidelines (CPGs). In this study we aim to evaluate the prevalence of COI reporting in gastroenterology (GI) guidelines from the United States and Europe. Methods: Nine GI societies websites in the US and Europe were reviewed for all published guidelines that used the GRADE methodology from 2013 to October 1, 2022. Guidelines were reviewed by one author to assess COI self-reporting, and COI details for authors. The conflicts were categorized as “research related payments”, “direct Payments” or “mixed: direct payments and research payments”. “Direct payments” conflicts such as speaker's bureau, stocks, consulting, advisory board, honoraria, non-research funding, and industry-sponsored continuing medical education activities. All included guidelines were assessed for publishing the evidence profile as another measure for transparency. Results: A total of 197 guidelines were reviewed. Of these, only 38/197 (19%) did not report COI or just provided a vague general statement regarding COI; Thirty-one (16%) provided only general statements about conflict of interest without details if they were present or not and 7 guidelines did not report COI. Across the remaining 159 guidelines, a total of 2,216 COIs were reported, with 65% (1,426/2,216) of them reported in the US guidelines (Figure 1A). There was a total of 2,346 authors across the reviewed guidelines, of which 29% had at least one COI reported. Of the COIs, 4% were from research related, 41% mixed between research and direct payments and the remaining 55% were categorized as direct payments (Figure 1B). Evidence profile were published in only 14.2% (28/197) of the guidelines, with 60% of them published in the supplement material, and 40% in the original paper. Conclusion: Transparency in reporting COI and decision making in how a recommendation is made is critical. About 19% of the included GI guidelines failed to report COIs in a clear way. Nearly 30% of the authors reported COIs; number of COIs was significantly higher in the US. Underreporting of COIs remains an issue. Additionally, there is a failure in reporting the evidence profile in the GI guideline, as it was as low as 14%. Therefore, we encourage a more rigorous COI management process for authors involved in producing GI guidelines and stress the importance of publishing evidence profiles to have increased transparency.Figure 1.: A: Guidelines Conflict of Interest in the US Guidelines vs Europe. B: Guidelines authors' conflict of interest by type.