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Statement from the American Gastroenterological Association on the integrity of AGA’s clinical guideline process

AGA Institute Clinical Guidelines Committee chair and chair-elect detail AGA's dedication to transparency in the development of clinical guidelines.
Man putting a ballot into a voting box.
Man putting a ballot into a voting box.

Bethesda, MD (Nov. 9, 2018) — Statement from Yngve T. Falck-Ytter, MD, AGAF, chair, and Shahnaz Sultan, MD, MHSc, AGAF, chair-elect, AGA Institute Clinical Guidelines Committee, in response to the research letter, “Evaluation of Industry Relationships Among Authors of Clinical Practice Guidelines in Gastroenterology,” by Tyler R. Combs, BS, et al., published in JAMA Internal Medicine on Oct. 29, 2018. 

The American Gastroenterological Association (AGA) understands how important it is for AGA members, patients, and the public at large to have access to the most trustworthy, actionable, and evidence-based guidelines in order to achieve the highest possible quality of patient care. In developing guidelines, our goal is to maintain a high level of methodologic rigor through the utilization of an evidence-based approach that is very transparent. 

However, not all clinical guidelines are created with equal rigor. Clinicians should examine guidelines closely and consider whether or not they follow the Academy of Medicine’s (formerly the Institute of Medicine’s) standards for trustworthy clinical guidelines. The guideline should be based on a systematic review of the evidence, focus on transparency, have a rigorous conflict of interest system in place, include the involvement of an unconflicted Grading of Recommendations Assessment, Development and Evaluation (GRADE) system-trained methodologist, ideally as a co-chair, and the recommendations should be concise and actionable. AGA follows a transparent, independent guideline development process that is not subject to company influence or bias and fully complies with the Academy of Medicine’s criteria for trustworthy guidelines.

AGA has been proactive in developing policies to minimize bias in our guidelines. AGA requires that the Chair of the Guideline Development Group, and a majority of Guideline (and other clinical practice documents) Development Group members are free of conflicts of interest relevant to the subject matter of the guideline. At the time of invitation, we ask our panel members to disclose any and all potential conflicts. Furthermore, all author disclosures are verified by means of accessing publicly available sources (such as the Centers for Medicare and Medicaid Services’ Open Payment database) prior to their involvement on the panel.  

AGA strives to be transparent in reporting commercial bias and independent of any industry influence in the development of our clinical practice documents. Our goal is to produce the most trustworthy, actionable, and evidence-based guidelines possible for our members. 

Learn more about AGA’s clinical guideline process.

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Media contact: Aimee Frank,, 301-941-2620