Industry payments and auditability of financial conflicts of interest in US gastroenterology and hepatology clinical practice guidelines: a cross-sectional analysis.

OBJECTIVE: To assess industry payments to guideline authors, disclosure concordance with actual payments, and the auditability of conflict-of-interest governance in contemporary US gastroenterology and hepatology guidelines. METHODS: Cross-sectional analysis of adult gastroenterology and hepatology guidelines published between 1 January 2019 and 31 December 2024, by the American Gastroenterological Association, American College of Gastroenterology, and American Association for the Study of Liver Diseases. Author disclosures were compared with manufacturer payments recorded in the Centers for Medicare and Medicaid Services Open Payments database during the 36 months preceding guideline acceptance or publication. Payments were considered relevant when originating from manufacturers of therapies recommended in the guideline. RESULTS: 13 guidelines, including 125 author appearances and 102 unique authors, met the inclusion criteria. 61 authors (48.8%) received at least one relevant manufacturer payment, with payments totalling US$1 733 865.58. Median payment among paid authors was US$9644.96. Disclosure discordance ranged from 0% to 85.7% across guidelines. Leadership roles were designated in 2 guidelines, and 4 of 13 met Institute of Medicine transparency standards. CONCLUSION: Financial relationships between guideline authors and manufacturers of recommended therapies were common, and many guidelines lacked governance structures permitting external audit. Standardised leadership designation and transparent author-level disclosure may strengthen credibility of future guidelines.