Truelove-Witts Severity Index for Ulcerative Colitis
Original (1955) and BSG-modified severity index for acute ulcerative colitis. Distinguishes mild / moderate / severe disease — severe disease (any criterion) requires inpatient admission per BSG / IBD-UK guidelines.
Score interpretation
→ Topical 5-ASA (mesalazine enema or suppository) for distal disease; oral 5-ASA (mesalazine 2–4 g/day) for extensive. Step up to combined topical + oral if no response at 4 weeks.
→ Combined oral + topical 5-ASA. If no response at 4 weeks: oral prednisolone 40 mg OD tapering over 8 weeks. Refer for biologic / JAKi if steroid-dependent or refractory.
→ Admit. IV hydrocortisone 100 mg QDS or methylprednisolone 60 mg OD. Daily abdominal X-ray (rule out toxic megacolon: transverse colon >5.5 cm), VTE prophylaxis with prophylactic LMWH, stool chart, CRP, AXR, CMV / C. difficile screening. Day-3 review for rescue therapy: Travis criteria — if stool frequency >8/day or 3–8 with CRP >45, predict 85% colectomy. Rescue with infliximab 5–10 mg/kg or ciclosporin 2 mg/kg/day; if no response in 4–7 days, colectomy.
Interpretation bands for the Truelove-Witts. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.