Letter: inflammatory bowel disease guidelines and conflicts of interest - authors' reply

Abstract

We thank Drs. Eliakim, Dignas and Travis for their comments1 concerning our manuscript.2 We commend the European Crohn's and Colitis Organisation (ECCO) for having a standard procedure for the development of guidelines, and insisting on disclosure of conflicts of interest (COI) from those involved in the guideline development process. As we noted in our manuscript, we can all agree that ECCO has taken many important steps in improving the guideline development process. However, we would like to note that while ECCO has updated their website, the webpage at the time of our study (30 September 2012) was ECCO's prior version of their website. As one may note, reference 25 in our manuscript is misquoted by Eliakim et al. The reference in our manuscript is https://www.ecco-ibd.eu/publications/ecco-guidelines-publications.html. The link we referenced has been taken down by ECCO and is no longer available. The new web page, as referenced in their letter, is https://www.ecco-ibd.eu/publications/ecco-guidelines-science/published-ecco-guidelines.html. The old website did not have any disclosures or comments regarding COI. Archived copies of the webpage cited in our manuscript are available at http://goo.gl/6AJbC. Additionally, we fundamentally disagree with the notion that if evidence was present, there would be, ‘no need for guidelines.’1 Authors of guidelines utilise the available evidence to form recommendations. Evidence is critical to the development of strong guidelines that clinicians rely on as the accepted standard of care. When evidence is not available, recommendations may be made, but it must be clear that the recommendations are only based on expert opinion. In this situation, a current best practice may be more appropriate than a guideline. As mentioned in our manuscript, this differentiation is key so that clinicians are aware when evidence is lacking, and if and when studies are performed, current practice may very well change. Use of the GRADE system would help differentiate between recommendations where the evidence is strong and further studies will not change current practice from recommendations where future studies are likely to change current practice. The authors' declarations of personal and financial interests are unchanged from those in the original article.2