Guideline development uses a formal series of steps that are time, resource, and labor intensive to produce recommendations that are likely to be trustworthy.1 The authors of the Toronto Consensus for the Treatment of Helicobacter pylori, published in this issue of Gastroenterology,2 followed such a rigorous process for producing their recommendations. Lack of important stakeholders (eg, primary care, infectious disease) on the panel was a shortcoming. In addition, systematic reviews were restricted to studies published from 2008 onward.