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A European consensus on anything is not easy to achieve, and inflammatory bowel disease (IBD) is no exception. The European Crohn’s and Colitis Organisation (ECCO), has now published the Consensus on the management of ulcerative colitis1–3 to complement the highly successful Crohn’s disease Consensus, which became the most downloaded papers from Gut in 2007.4–6 A further European Consensus on opportunistic infections and IBD, to be published during 2008 and an update of the Crohn’s Consensus presented at the United European Gastroenterology Week (UEGW) in Vienna, are the product of a formal process, and hence the capital C in Consensus.
The limits of evidence-based medicine are such that guidelines appear most necessary where evidence is limited. The Consensus process endeavours to quantify opinion through a detailed preparatory phase, with systematic literature searches on selected topics, questionnaires on areas of controversy and grading of evidence according to the Oxford Centre for Evidence Based Medicine, from the optimal 1a (systematic review with homogeneity of randomised controlled trials) to the lowest level 5 (expert opinion, even including our own).1 4 Based on the evidence levels, recommendations are graded from A (consistent level 1 studies) to D (level 5 evidence). Preliminary statements are then drafted by working parties, discussed and modified at a plenary meeting of experts (72 from the then 22 countries of ECCO in the ulcerative colitis Consensus). Consent has to prevail over dissent and evidence over eminence: habemus consensus, formally defined as >80% agreement, a majority vote for 50–80% agreement and no consensus for <50% accord. The statements, forged as if from molten metal at the plenary session, provide the framework for the guideline. The supporting text is then written by the working parties to place statements in the necessary context and collated into the …