31 WORLD GASTROENTEROLOGY NEWS APRIL 2015 Editorial | Expert Point of View | Gastro 2015: AGW/WGO | WDHD News | WGO & WGOF News | WGO Global Guidelines | Calendar of Events pharmaceutical industry public programs, and local and global meeting programs. A good example initiative is our participation in the scientific program at the Gastro 2015 meeting in Brisbane, Australia in September of this year. Global access is important for our mission. From the top six most common languages in the world (English, French, Mandarin, Portuguese, Russian, and Spanish) we are still missing Hindi and Arabic – remains of a still rather ‘Western’ focus? Use & Implementation – Clinical practice guidelines will not have achieved their stated purpose if clinical practice does not change and outcomes improve. Although some implementation and impact studies have been published, little is known about the applicability of guidelines at a truly global level. We also don’t know enough about the impact or implementation of our guidelines; we know visits and downloads and we plan to soon start a tool to get to know more about who is downloading and using our guidelines. Guidelines are updated as needed – we generally use a limit of five years, but the speed at which guidelines become outdated depends on the topic and scientific development factors. WGO’s Guidelines Committee meets once a year and decides on new titles and updates. More new titles means more updating in the future, another challenge, especially in view of our more or less fixed resources. We are currently testing a short-track updating procedure. Evidence – evidence based medicine is important and numerous excellent ‘gold standard’ guidelines are available for many GI topics which represent the latest scientific achievements. However, for most parts of the world, being able to “implement and practice what is already known” will do more good than “increasing the Title Year Cascades Published Languages 1. Dysphagia 2014 + WGO 6 2. Esophageal Varices 2014 + WGO+NGC 6 3. Common GI Symptoms 2013 + WGO+JCG 5 -R 4. Hepatitis C 2013 + WGO+JCG 4 -F-R 5. Acute Diarrhea 2012 + WGO+NGC+JCG 6 6. Celiac Disease 2012 + WGO+NGC+JCG 6 7. NAFLD & NASH 2012 + WGO+JCG 5 -R 8. Endoscope Disinfection 2011 + WGO 6 9. Obesity 2011 + WGO+NGC+JCG 6 10. Probiotics and Prebiotics 2011 - WGO+JCG 6 11. Constipation 2010 + WGO+JCG 6 12. Helicobacter Pylori in Developing Countries 2010 + WGO+JCG 6 13. Hepatocellular Carcinoma 2009 + WGO+JCG 6 14. Inflammatory Bowel Disease 2009 + WGO+JCG 6 15. Inflammatory Bowel Syndrome 2009 + WGO 6 16. Radiation Protection in the Endoscopy Suite 2009 + WGO 6 17. Hepatitis B 2008 + WGO 6 18. Colorectal Cancer Screening 2007 + WGO+JCG 6 19. Diverticular Disease 2007 - WGO 6 20. Strongyloidiasis 2004 - WGO 6 21. Acute Viral Hepatitis 2003 - WGO 6 22. Asymptomatic Gallstone Disease 2002 - WGO 5 -M F = French, M = Mandarin, R= Russian evidence.” That is where our Global Guidelines play a role. In our guideline development we balance limited evidence with expert consensus. It is a delicate balancing act, and isn’t evidence too a man made thing? Isn’t evidence too ‘not so objective’: What we want to see is what we get? How do WGO guidelines differ from national or other ‘global’ guidelines? It is through our WGO Cascades that we differ. Very simply said, they address what can be done when you do not have all or optimal resources available. Resources in our view and in relation to our practice guidelines include, in addition to financials: material and technical capabilities, access to information and education, experience and training, legal and distribution limitations, and health care organization and patient access. As a consequence, we focus on developing regions or economies concentrated in Latin America, Russia, China, India, Pakistan, and Africa. There are numerous ‘gold standard’ guidelines available, but not many address the implications of the requirements to fully implement those gold standard guidelines. A practical example is the reuse of ‘disposable’ syringes or the alternative cleaning of endoscopes with water and soap (because the autoclave is broken and there is no money for new parts). However, an example of how nearby and maybe unexpected, resource limitations can be is the fact that in Sweden, for instance (and in Holland and the UK and several other regions in Europe),
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