Quality assessment of clinical practice guidelines for eosinophilic esophagitis using the AGREE II instrument

Background: High-quality evidence-based clinical practice guidelines can guide diagnosis and treatment to optimize outcomes. We aimed to systematically review the quality of international guidelines on eosinophilic esophagitis (EoE). Methods: MEDLINE and Scopus databases were searched for appropriate guidelines up to 2016. Two gastroenterologists and two methodologists independently evaluated the documents using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Results: Amongst the 25 records initially retrieved, four guidelines developed by recognized scientific organizations met inclusion criteria. AGREE II results varied widely across domains, but none achieved an overall assessment score of over 60%. Scope and purpose (61.82 +/- 19.24%), clarity of presentation (57.13 +/- 40.56%) and editorial independence (93.75 +/- 1.69%) showed the highest mean rating, whereas stakeholder involvement (28.82 +/- 11.19%), rigor of development (32.29 +/- 12.02%) and applicability (21.62 +/- 7.14%) did not reach quality thresholds. Intraclass correlation coefficients for agreement was excellent among appraisers (0.903), between gastroenterologists and methodologists (0.878) and for each individual guideline (0.838 to 0.955). Conclusion: Clinical practice guidelines for EoE vary significantly in quality, are invariably limited and currently, none can be 'strongly recommended'.