25 WORLD GASTROENTEROLOGY NEWS OCTOBER 2017 Editorial | Expert Point of View | WCOG at ACG 2017 | WDHD News | WGO & WGOF News | WGO Global Guidelines | Calendar of Events tion. During my career, I travelled to many developing countries where I was confronted with and frustrated by the fact that local medical workers try to apply ‘American’ guidelines, guidelines that were totally incompatible with the local situation of the doctors looking for clinical recommendations. There was an enormous gap between medical care and medical knowledge in developing countries compared with the developed world. I am convinced that there is only one global medical truth, one that changes every day, but nevertheless a universal truth no matter where you live and where you catch an illness. I was frustrated too by all the transla-tions that appeared while I believe there should be one universal language so that we all understand each other, similar to the aviation industry: pilots have one common language and one shared set of instructions to prevent chaos and to promote the highest quality action. There is a plethora of medical practice guidelines but I believe that eventu-ally we have to get to a global system of universal guidelines, which, of course, would require a layered system with op-tions for situations that do not allow or call for the most expensive or technically advanced solutions. Countries with lim-ited resources cannot be forced to this. But I am convinced there is a common base that should be universal and I have always thought that it fits a global orga-nization, which is an amalgam of what should happen in the world anyway, to take responsibility for this. For instance, for inflammatory bowel disease there are at least thirty, forty dif-ferent disease grading systems. Each and every group is developing its own and this has led to a senseless proliferation that has a negative impact on medical care and represents a huge loss of energy. Functional afflictions such as dyspepsia, constipation, and reflux, and even more, Crohn’s disease and ulcerative colitis, would greatly benefit from a universal grading approach, and of course this would be a ‘live’ system that needs main-tenance and updates every two years or so. I am convinced this would be very useful and would benefit patient care and health science all over the world. The work of the Rome Foundation is an example of how to get closer to such a universal approach and to develop a common set of criteria for the man-agement of functional symptoms and disorders in GI, but also for universal criteria for the inclusion of patients in medical trials. And that is why we started with the first WGO Global Guidelines, which I at first developed on my own in an almost ‘embryonic’ state, Needlestick Injury for instance, but that now has be-come a professional program with teams, chairpersons, and updating procedures, and later on with cascaded options for situations where the gold standard is out of reach. I am involved in several activities fo-cusing on the education of GI specialists and publication of scientific develop-ments. For instance, Gastro Update which is a two-day European mini conference for those who want to stay up to date in gastroenterology. Some four-teen top experts in GI prepare lectures and presentations. In order to be able to do this work, and to justify my overview role, I have to stay abreast of new devel-opments, insights, and opinions, and so I go to the Amsterdam Medical Center every week to read the journals. In order to promote representation of data and expertise we now aim for guideline development teams with experts from all over the world. As a Professor Tytgat at his home in Amsterdam, 7 July 2017 world organization we should ask our national member societies to partici-pate in this in a most structured way by asking their top experts to work on specific guideline sections based on local experience and practice, and evidence and data from regional studies published in their own language. The resulting ‘cascaded’ recommendations are then to be discussed and accepted at a next WGO meeting and its consistent high-quality level should convince others to choose these global guidelines above regionally developed non-universal alternatives. It would promote gastro-enterology and hepatology at large, help practicing clinicians, and make medical care universal, accessible, and deal with inequality. Does it help to produce global guide-lines? All (evidence based) guidelines lack proof that their recommendations when implemented universally improve the quality of health care, and the same is valid for the training centers and other educational initiatives, the required budgets and time to do research on this are simply prohibitive, but it would be very useful to know what the impact of our work is. In order to promote representation of data and expertise we now aim for guideline development teams with experts from all over the world. Certain epidemiological differences are rapidly decreasing due to the relocation and mixing of populations everywhere, through international travel, immigration and refugees…
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