Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The Truelove and Witts index for ulcerative colitis severity calculator assesses the severity of ulcerative colitis based on six user-provided clinical parameters. These parameters include the number of bowel movements per day, the presence and amount of blood in stool, body temperature, pulse rate, hemoglobin levels, and the erythrocyte sedimentation rate (ESR).

The user selects from predefined options for each parameter:

1. Bowel movements per day: "5", "<= 4", ">= 6".
2. Blood in stool: "None or small amounts of macroscopic blood", "Between visible and small amount of blood", "Visible macroscopic blood".
3. Temperature >= 37.8 degrees C (100.04 degrees F): "No", "Yes".
4. Pulse > 90 bpm: "No", "Yes".
5. Hemoglobin <= 105 g/L: "No", "Yes".
6. Erythrocyte sedimentation rate, mm/hour: "<= 30", "> 30".

The calculator interprets these inputs to classify the ulcerative colitis severity as mild, moderate, or severe according to specific criteria.

The decision process involves evaluating each input combination:

1. Mild ulcerative colitis is determined if:
   - Bowel movements are exactly 5.
   - Blood in stool is none or small amounts of macroscopic blood.
   - Temperature is below 37.8 degrees C.
   - Pulse is 90 bpm or less.
   - Hemoglobin is above 105 g/L.
   - ESR is 30 mm/hour or less.

2. Severe ulcerative colitis is identified if:
   - Bowel movements are 6 or more.
   - Blood in stool is visible macroscopic blood.
   - Temperature is 37.8 degrees C or higher.
   - Pulse exceeds 90 bpm.
   - Hemoglobin is 105 g/L or less.
   - ESR exceeds 30 mm/hour.

3. In any other combination not fitting the above criteria, the condition is considered moderate ulcerative colitis.

Upon computation, the result stating the severity level (mild, moderate, severe) is returned. This assessment assists in clinical decision-making by categorizing the disease's current impact on the patient, facilitating appropriate management and treatment strategies. If any inputs are missing or not selected, an instructions prompt to complete all inputs is displayed.

The Truelove and Witts Index is a clinical calculator used to assess the severity of ulcerative colitis, a chronic inflammatory bowel disease. This index is applicable to patients diagnosed with ulcerative colitis and is used to guide treatment decisions and predict disease prognosis. 

The Truelove and Witts Index takes into account several parameters including number of bowel movements, presence of blood in stool, temperature, pulse rate, hemoglobin level, and erythrocyte sedimentation rate (ESR). Based on these parameters, the severity of ulcerative colitis is classified as mild, moderate, or severe.

The clinical utility of this calculator lies in its ability to stratify patients according to disease severity, which can help clinicians decide on the appropriate level of intervention, ranging from outpatient management to hospital admission and aggressive treatment. 

There are no specific exclusion criteria for the use of the Truelove and Witts Index. However, it may not be as accurate in patients with atypical presentations of ulcerative colitis or in those with co-existing conditions that could affect the parameters used in the index.

Truelove and Witts index for ulcerative colitis severity

Ulcerative colitis

Patients with Clostridioides difficile infection

Patients with C. difficile infection, withholding immunosuppressive therapy

Nutritional support

Nutritional support (vitamin supplements)

Follow-up

Management of pouchitis

Management of pouchitis (fecal microbiota transplantation)

Management of anemia

Management of anemia, iron supplementation

Indications for urgent surgery

Indications for urgent surgery, perforation

Maintenance of remission

Maintenance of remission (moderate-to-severe disease, 5-ASAs)

Patients with ostomy

Diagnostic imaging

Maintenance of remission, moderate-to-severe disease, advanced therapy

Management of pouchitis (management of cuffitis)

Nutritional support (enteral nutrition)

Preoperative counseling

Induction of remission

Induction of remission (moderate-to-severe disease, aminosalicylates)

Probiotics

Surgical approach

Perioperative nutrition

Patients with C. difficile infection, antibiotic therapy

Maintenance of remission (moderate-to-severe disease, corticosteroids)

Nutritional support (avoidance of dehydration)

Induction of remission, mild-to-moderate disease

Nutritional support, general principles

Induction of remission, moderate-to-severe disease, advanced therapy

Fecal microbiota transplantation

Nutritional support (avoidance of refeeding syndrome)

Nutritional support, parenteral nutrition

Fecal calprotectin

Management of acute complications

Routine immunizations

Lower gastrointestinal endoscopy

Management of pouchitis, antibiotics

Dietary modifications

General principles

Management of acute severe ulcerative colitis

Management of acute severe UC

Maintenance of remission (antibiotics)

Screening for anxiety and depression

Management of inadequate treatment response

Management of inadequate treatment response (mild-to-moderate disease)

Management of pouchitis (mesalamine)

Induction of remission, moderate-to-severe disease, tiopurines and methotrexate

Assessment of acute abdomen

Indications for urgent surgery, uncontrolled bleeding

Colorectal cancer surveillance

CRC surveillance

Skin cancer surveillance

Clinical monitoring

Management of inadequate treatment response, moderate-to-severe disease

Indications for urgent surgery, toxic megacolon

Patients with C. difficile infection, fecal microbiota transplantation

Flexible sigmoidoscopy

Pregnant patients

Pregnant patients (surgical management)

Assessment of disease activity

Indications for urgent surgery (intestinal obstruction)

Management of anemia (management of recurrence)

Indications for elective surgery

Infectious workup

Management of anemia (RBC transfusion)

Nutritional support, management of malnutrition

Induction of remission, moderate-to-severe disease, corticosteroids

Diagnosis

Management of pouchitis (immunosuppressive therapy)

Screening for osteoporosis

Management of pouchitis (management of Crohn's-like disease)

Maintenance of remission, moderate-to-severe disease, thiopurines and methotrexate

Physical activity

Nutritional support (energy requirements)

Antibody testing

Indications for urgent surgery, acute severe UC

Management of anemia (management of non-IDA anemia)

Nutritional support (counseling)

Classification and severity assessment

Updated 2024 AGA guidelines for the management of pouchitis


Updated 2024 AGA guidelines on diet and nutritional therapy in ulcerative colitis


Updated 2024 AGA guidelines for pharmacological management of moderate-to-severe ulcerative colitis


Ulcerative colitis

Background

Overview

Guidelines

Key sources