title: Quality assessment of clinical practice guidelines for eosinophilic esophagitis using the AGREE II instrument.
abstract: 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).
  
  
  CONCLUSIONS
  Clinical practice guidelines for EoE vary significantly in quality, are invariably limited and currently, none can be 'strongly recommended'.
authors.affiliation: a Department of Gastroenterology , Hospital General de Tomelloso , Tomelloso , Spain.|b Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) , Madrid , Spain.
authors.forename: Alfredo J
authors.initials: AJ
authors.lastname: Lucendo
authors.affiliation: b Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) , Madrid , Spain.|c Research Support Unit , Hospital General La Mancha-Centro , Alcázar de San Juan , Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Arias
authors.affiliation: c Research Support Unit , Hospital General La Mancha-Centro , Alcázar de San Juan , Spain.
authors.forename: Olga
authors.initials: O
authors.lastname: Redondo-González
authors.affiliation: b Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) , Madrid , Spain.|d Department of Gastroenterology , Hospital San Pedro de Alcántara , Cáceres , Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Molina-Infante
mesh_terms: D057765:Eosinophilic Esophagitis / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D015588:Observer Variation; D017410:Practice Guidelines as Topic / Q000592:standards*; D011237:Predictive Value of Tests; D019984:Quality Indicators, Health Care / Q000592:standards*; D015203:Reproducibility of Results; D016896:Treatment Outcome
keywords: Eosinophilic esophagitis; food allergy; guidelines; quality; recommendation