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Are global guidelines desirable, feasible and necessary?

Nature Clinical Practice Gastroenterology & Hepatology volume 5, pages 2–3 (2008)Cite this article

Guidelines matter.1 The medical literature is awash with guidelines and the field of gastroenterology is no exception. Medical organizations that create guidelines face difficult challenges and guidance is needed.2 Firstly, if guidelines are to be truly evidence-based, all recommendations should be supported by up-to-date systematic reviews. Such reviews can, however, be very costly if adherence to strict standards is maintained. Secondly, the impact of such guidelines on medical practice, or on such outcomes as mortality or morbidity, has been scarcely documented. Thirdly, are guidelines developed in large part in Western countries really useful and relevant to resource-poor, less-developed countries? This last issue is of particular relevance to the World Gastroenterology Organization (WGO) given its special interest in training and education in gastroenterology and the care of digestive disorders in developing nations. The WGO has attempted, when developing guidelines, to place emphasis on topics of importance to the developing world and to tailor its recommendations to the capabilities of poorer health-care systems. The WGO established a task force early in 2005 to identify the key issues in the development and implementation of global guidelines.3

This task force laid the framework for cascades. A cascade is a collection of related diagnostic and treatment options arranged hierarchically in terms of conditions and available resources. For guidelines to work, cascades need to be built into them. Guidelines without cascades are resource-blind and will not work in most of the world.4

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Authors and Affiliations

  1. Michael Fried is Director of the Division of Gastroenterology and Hepatology at the University Hospital Zürich, Zürich Switzerland,

    M Fried

  2. Eamonn MM Quigley is President of the World Gastroenterology Organisation and Professor of Medicine and Human Physiology at the University College Cork, Cork, Ireland,

    EMM Quigley

  3. Richard H Hunt is Professor of Medicine and Gastroenterology at McMaster University Health Science Centre, Hamilton, ON, Canada,

    RH Hunt

  4. Gordon Guyatt is a Professor in the Department of Clinical Epidemiology and Biostatistics and the Department of Medicine at McMaster University, Hamilton, ON, Canada,

    G Guyatt

  5. Benjamin O Anderson is Professor of Surgery at the University of Washington, Joint Member at the Fred Hutchinson Cancer Research Center in Seattle, WA, USA, and Chair and Director of the Breast Health Global Initiative,

    BO Anderson

  6. David J Bjorkman is Dean of the University of Utah School of Medicine, Salt Lake City, UT, USA,

    DJ Bjorkman

  7. Michael JG Farthing is the Vice Chancellor of the University of Sussex, Brighton, UK,

    MJG Farthing

  8. Suleiman S Fedail is Chairman of Fedail Medical Center, Khartoum, Sudan,

    SS Fedail

  9. Ronald Green-Thompson is a Professor in the Kwa-Zulu Natal Department of Health, Durban, South Africa,

    R Green-Thompson

  10. John Hampton is Emeritus Professor of Cardiology at the Queens Medical Centre, University Hospital of Nottingham, Nottingham, UK,

    J Hampton

  11. Justus Krabshuis, Director of Highland Data, Tourtoirac, France,

    J Krabshuis

  12. Loren Laine, Professor of Medicine at the University of Southern California School of Medicine, Los Angeles, CA, USA,

    L Laine

  13. Richard Horton is Editor-In-Chief of The Lancet, London, UK,

    R Horton

Authors
  1. M Fried
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  2. EMM Quigley
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  3. RH Hunt
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  4. G Guyatt
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  8. SS Fedail
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  10. J Hampton
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  11. J Krabshuis
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  12. L Laine
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  13. R Horton
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Correspondence to M Fried.

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The authors declare no competing financial interests.

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Fried, M., Quigley, E., Hunt, R. et al. Are global guidelines desirable, feasible and necessary?. Nat Rev Gastroenterol Hepatol 5, 2–3 (2008). https://doi.org/10.1038/ncpgasthep0994

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