The use of consensus to develop guidelines for the management of Helicobacter pylori infection in primary care

Background. Guidelines are an increasingly important feature of clinical pr actice and have proliferated over the past decade, When the evidence base f or effective practice is limited, guidelines have to derive from the opinio ns and experience of those with knowledge of the subject. The manner in whi ch a group synthesizes its individual opinions, the consensus process, is c entral to the validity and applicability of the resulting recommendations. This paper considers the theoretical issues in consensus development and de scribes the consensus process used in developing the European Society for P rimary Care Gastroenterology guidelines for the management of Helicobacter pylori in primary care. Methods. A consensus development conference of 48 GPs from nine European co untries used case scenarios to define clinical management strategies in dys pepsia and H.pylori infection. Structured data collection from this meeting allowed a quantitative measure of the extent of consensus to be produced. Results. Specific recommendations were produced for 15 decision points rele vant to the management of H.pylori infection in primary care. Discussion. Consensus development is often utilized in the production of gu idelines for clinical practice. Guideline appraisal instruments fail to exa mine in depth the methods used for this important part of the development p rocess. We describe an approach to consensus development which contains a s imple measure of the strength of consensus underlying each recommendation.