Quality assessment of clinical guidelines on probiotics therapy in children with IBD using the AGREE II instrument
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Published on: April 28, 2014
Haixin Cheng1, Ziyin Ma2, Boran Yu3
1Department of Pharmacy, Children's hospital of capital Institute of Pediatrics, Beijing, China.
Insights
High-quality guidelines exist for pediatric inflammatory bowel disease (IBD), but recommendations for probiotic use are inconsistent. Probiotic use in Crohn
Area of Science:
- Pediatric Gastroenterology
- Microbiome Research
- Evidence-Based Medicine
Background:
- Pediatric inflammatory bowel disease (IBD) incidence is rising.
- Probiotic efficacy in IBD is debated.
- Clinical guidance for pediatric IBD treatment is evolving.
Purpose of the Study:
- To systematically review and summarize recommendations on probiotic use in pediatric IBD from high-quality clinical guidelines.
- To provide clinicians with evidence-based insights for managing pediatric IBD.
Main Methods:
- Searched multiple databases (PubMed, EMBASE, Chinese databases) for guidelines on pediatric IBD treatment.
- Evaluated guideline quality using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument.
- Assessed recommendation levels and summarized findings on probiotic application.
Main Results:
- 14 guidelines met inclusion criteria; 12 were evidence-based.
- High AGREE II scores for 'Scope and purpose' (97.22%) and 'Clarity of presentation' (93.78%).
- Overall guideline quality was high, with 3 receiving 'Strongly recommended' (Grade A) and the rest 'Recommended with modifications' (Grade B).
Conclusions:
- While overall guideline quality is high, specific recommendations for probiotic use in pediatric IBD are inconsistent.
- No guidelines provided recommendations for probiotics in Crohn's disease (CD).
- Recommendations for ulcerative colitis (UC) varied, with some suggesting VSL#3 or Escherichia coli Nissle 1917.
What Is Known And Objective:
The morbidity of inflammatory bowel disease (IBD) in children has significantly increased in recent years. The diagnosis and treatment of IBD in children are progressing rapidly. Probiotics have been extensively studied in a variety of gastrointestinal diseases. However, the effectiveness of probiotics for IBD is inconsistent. This study summarized the recommendations on using probiotics from high-quality guidelines, and the recommendations may assist clinicians in the treatment of paediatric IBD.
Methods:
Guidelines were identified by searching PubMed, EMBASE, three Chinese literature databases and websites of relevant institutions. Guidelines that addressed the treatments of paediatric IBD in Chinese and English were included and evaluated with the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument to assess methodological quality. The levels of recommendation were also evaluated, and finally, the recommendations of probiotics application in IBD were summarized.
Results And Discussion:
A total of 14 guidelines that met inclusion criteria were identified and evaluated, and 12 of them were evidence-based (EB) guidelines, and the other two guidelines were developed by consensus. The mean percentages for the AGREE II domain scores were as follows: "Scope and purpose" 97.22%, "Clarity of presentation" 93.78%, "Applicability" 55.85%, "Editorial independence" 59.92%, "Stakeholder involvement" 74.34%, and "Rigor of development" 71.58%. Three guidelines received the Grade A-"Strongly recommended," the rest of the guidelines received a B grade-"Recommended with modifications" in the overall assessment.
What Is New And Conclusion:
The overall quality of the guidelines on IBD management in children was high. Conversely, the fundamental recommendations on the application of probiotics in the treatment of IBD varied. For instance, the recommendations of probiotics on Crohn's disease (CD) were not available by any of the analysed guidelines, the recommendations of utilizing probiotics in treating ulcerative colitis (UC) were not uniform as several guidelines considered using VSL#3 or Escherichia coli Nissle 1917 for the treatment.
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