INTRODUCTION: We aimed to analyze gastrointestinal guidelines to assess the quality of evidence and strength of recommendation. METHODS: We abstracted clinical practice guidelines and guidance statements from 4 American gastroenterology societies (American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, and American Association for the Study of Liver Disease) and the US Multi-Society Task Force. RESULTS: Of the 3,609 statements analyzed, only 13% were supported by high level of evidence. The number of statements published annually is increasing, but the level of evidence supporting recommendations is declining over time. DISCUSSION: This analysis highlights the need for high quality research in gastroenterology to support the development of stronger evidence-based guideline statements.