Title: Cochrane systematic reviews on priority topics in the diagnosis and management of liver, gallbladder, and biliary tract disorders
Funder: Department of Health and Social Care

Abstract: Medicine has undergone a major transformation over the last 20 to 25 years with a rapid increase in the volume and nature of interventions and diagnostic tests for patients with upper digestive disorders. Patients, clinicians, and healthcare funders need an up-to-date and authoritative source of information to guide evidence-based investigations and treatment of these disorders, preferably high quality systematic reviews. Cochrane systematic reviews satisfy most of these criteria. While we have covered many important topics related to the upper digestive tract diseases field in our previous NIHR Cochrane programme grants, the James Lind Alliance - Priority Setting Partnership (JLA-PSP) process that has been completed on alcohol-related liver disorders and the one that we are currently undertaking on non-alcohol related liver and gallbladder disorders has shown that many research questions have not been covered in the previous grants. In addition, methodology is now available to allow simultaneous comparison of multiple interventions [network meta-analysis (NMA)] which provides an opportunity to obtain additional information from previously published trials. As a part of this programme, we will complete 2 to 3 diagnostic test accuracy reviews (DTAR) and 7 to 8 intervention reviews (including NMAs when appropriate) on topics prioritised by the JLA-PSP process on alcohol-related liver disorders and the one that we are currently undertaking on non-alcohol related liver and gallbladder disorders. We will perform individual participant data (IPD) NMAs on topics in which IPD is expected to improve the results significantly more than metaregression. This project will identify the clinically effective interventions and diagnostic tests, a proportion of which will be cost-effective in the NHS setting. The collaborators in this grant include clinicians who manage these conditions in NHS, patient representatives, editors, and co-ordinating editors of the CHBG (Cochrane Hepato-Biliary Group). We will also seek advice from the NIHR Complex review Support Group for complex reviews.

Lay abstract: Liver and gallbladder are digestive organs in the upper part of the abdomen (tummy). In the field of liver and gallbladder medicine and surgery, many new studies have been performed over the last 20 to 25 years. This has led to changes in the investigations (tests) used to find out if a person has liver or gallbladder disorders (diseases) and the treatments used for these diseases. Patients, clinicians, and healthcare funders need an up-to-date and authoritative source of information to guide evidence-based investigations and treatment of these diseases, so that appropriate and informed decisions can be made. Systematic reviews involve compiling all the evidence available in the medical literature to find out good a test differentiates people with and without diseases and how well a treatment works. Systematic reviews of high quality studies provide the best level of evidence on the usefulness of a test or treatment. Cochrane systematic reviews are high quality systematic reviews and provide patients, clinicians, and healthcare funders an up-to-date and authoritative source of information on tests and treatments. While we have covered many important topics related to the liver and gallbladder disorders in our previous NIHR Cochrane programme grants, the James Lind Alliance - Priority Setting Partnership (JLA-PSP) (a collaboration between patients, their carers, and the clinicians who treat them to find out what are the most important questions that need to answered in further research) that has been completed on alcohol-related liver disorders and the one that we are currently undertaking on non-alcohol related liver and gallbladder disorders has shown that there are no Cochrane reviews or high quality systematic reviews for many questions that are important to patients, their carers, and the clinicians who treat them). Traditionally, it was only possible to compare two treatments at a time in systematic reviews. Advanced methods are now available to allow simultaneous comparison of multiple treatments, which provides an opportunity to obtain additional information from previously published studies. We will also contact the study authors to obtain additional information to improve the conclusions that we make from studies. As a part of this programme, we will complete 10 Cochrane reviews on topics considered to be important to patients with liver and gallbladder diseases, their carers, and the clinicians who treat these diseases). This project will identify how good the tests and treatments are. The collaborators in this grant include clinicians who manage these conditions in NHS, patient representatives, and methodological experts.

Research activity codes: 4.2 EVALUATION OF MARKERS AND TECHNOLOGIES;6.1 PHARMACEUTICALS;6.4 SURGERY;6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: CANCER AND NEOPLASMS;INFECTION;ORAL AND GASTROINTESTINAL