Clinical decision support

Decision support tools

Guideline-anchored tools that show which published recommendations apply to a given clinical situation. Every recommendation is quoted verbatim from the cited guideline and machine-verified against its full text. These tools surface the evidence, they do not predict outcomes or replace clinical judgment.

Practice guidelines and risk calculators

Third-party guidelines and prediction tools relevant to ulcerative colitis, each independently verified against PubMed. These are external documents and tools, linked, not reproduced, and not evidence-gated by this site.

Practice guidelines

• ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment ECCO · 2026 · PMID 42413123 · J Crohns Colitis
  Medical escalation across mild-to-moderate, moderate-to-severe AND acute severe UC (ASUC), including FMT; the 2026 restructure moved ASUC out of the surgical paper into this one.
• ECCO Guidelines on Therapeutics in Ulcerative Colitis: Surgical Treatment ECCO · 2026 · PMID 42381162 · J Crohns Colitis
  Surgical strategy for medically refractory UC: colectomy timing/staging, perioperative optimisation, restorative proctectomy with IPAA vs IRA, and required centre/surgeon volume and specialisation.
• Clinical Practice Guideline for the Surgical Management of Ulcerative Colitis ASCRS · 2026 · PMID 42165399 · Dis Colon Rectum
  North American surgical standard, operative choice in refractory/fulminant UC, staging of IPAA, and UC-associated neoplasia (explicitly rejects watch-and-wait for UC-associated adenocarcinoma).
• ACG Clinical Guideline Update: Ulcerative Colitis in Adults ACG · 2025 · PMID 40701556 · Am J Gastroenterol
  Diagnosis, activity/severity assessment, monitoring, advanced-therapy positioning, ASUC management and surgical considerations; also defines poor-prognosis features.
• AGA Living Clinical Practice Guideline on Pharmacological Management of Moderate-to-Severe Ulcerative Colitis AGA · 2024 · PMID 39572132 · Gastroenterology
  Drug-by-drug positioning for moderate-to-severe UC using comparative-efficacy 'buckets' across all 12 advanced therapies, plus combination therapy and de-escalation.
• British Society of Gastroenterology guidelines on inflammatory bowel disease in adults: 2025 BSG · 2025 · PMID 40550582 · Gut
  Full-spectrum UC and Crohn's medical plus surgical management with an accompanying network meta-analysis of induction/maintenance agents; the UK reference standard.
• ESPEN guideline on Clinical Nutrition in inflammatory bowel disease ESPEN · 2023 · PMID 36739756 · Clin Nutr
  71 recommendations including a surgical chapter, the reference for preoperative nutritional optimisation and sarcopenia/hypoalbuminaemia correction before colectomy or IPAA.

Risk calculators and prediction tools

• Truelove & Witts Severity Index live calculatornot validatedClassifies UC as mild / moderate / severe. Its 'severe' category IS the operational definition of acute severe UC (ASUC) and therefore the trigger for admission and IV corticosteroids. · PMID 13260656 Note: A 1955 classification, not a prediction model. It has never been validated to predict steroid failure or colectomy, and must not be used for that. It contains no endoscopic component. The near-universal ESR-to-CRP substitution rests on guideline convention and a small correlation study, not formal revalidation. Only ONE systemic criterion beyond >=6 bloody stools/day is needed to trigger 'severe', so it is deliberately sensitive, not specific.
• UCEIS (Ulcerative Colitis Endoscopic Index of Severity) live calculatorexternally validatedGrades endoscopic severity (3-11 scale; equivalently 0-8). Higher scores associate with steroid non-response, mesalazine failure and colectomy; it is also the endoscopic input to ADMIT-ASC. · PMID 21997563 Note: Best-validated endoscopic index in UC, but inter-observer reliability is only moderate (kappa ~0.50). A one-point disagreement between two competent endoscopists is normal and can flip an ADMIT-ASC band. MDCalc explicitly states no management recommendations are based on UCEIS. The circulating action thresholds (>=4 escalate, >=7 colectomy risk) come from single-centre cohorts and the ADMIT-ASC derivation, not from a trial; do not treat any cut-point as a surgical indication. Reliability paper is PMID 23891974.
• Oxford (Travis) Criteria, day 3 of ASUC live calculatorexternally validatedOn day 3 of IV corticosteroids, flags patients likely to fail medical therapy. Originally derived to predict colectomy on that same admission; in practice now used to time rescue therapy. · PMID 8984031 Note: EXTERNALLY VALIDATED AND IT FAILED. The famous '85% will need colectomy' figure does not hold today. Independent validation (Dig Dis Sci 2019, PMID 31093812) found only 36% of criteria-positive patients underwent in-hospital colectomy, versus 9.5% of criteria-negative. A 2025 post-biologic cohort (n=261) gave sensitivity 58.6%, specificity 71.9%, AUC 0.65 for steroid non-response, with an in-hospital colectomy rate of just 8%. Derived pre-biologics from 51 episodes in 49 patients at one hospital. Legitimate use: a prompt to escalate and involve surgery. Illegitimate use: quoting 85% to a patient, or treating it as an indication to operate.
• ADMIT-ASC (Admission Model for Intensification of Therapy in Acute Severe Colitis) formula only, no calculatorexternally validatedPredicts non-response to IV corticosteroids (defined as rescue therapy or colectomy during that admission) using data available on the DAY OF ADMISSION rather than day 3. · PMID 36171080 Note: The best externally validated ASUC tool (Oxford derivation n=131 admissions; independent validation in Australia n=110 and India n=62), but note three limits. (1) It predicts STEROID non-response, not colectomy; do not read it as a colectomy probability. (2) The headline '0 and 4 were 100% predictive' applies to very few patients, most cluster in the indeterminate middle. (3) It requires a UCEIS, so it is unusable if flexible sigmoidoscopy is deferred. No free standalone web calculator exists; the score table is in the Gut paper.
• Le Baut score (1-year colectomy risk after ASUC admission) paywalledexternally validatedStratifies risk of colectomy within 1 year of an ASUC hospitalisation, the only tool here aimed at the medium-term horizon rather than the index admission. Score 0 = low risk (candidate for early oral transition and discharge); 3-4 = high risk. · PMID 31927106 Note: Derived retrospectively from two French centres (n=270, 2002-2017) and validated in an external cohort by the same group; I found no independent replication by unrelated investigators. The derivation window closed before ustekinumab, JAK inhibitors and S1P modulators reached UC practice, so the 1-year colectomy risk it encodes is very likely an overestimate for a patient treated in 2026. No web calculator; paywalled in Clinical Gastroenterology and Hepatology.
• Ho Index (Edinburgh score) live calculatorderivation cohort onlyDay-3 prediction of IV corticosteroid failure in ASUC; an alternative to the Oxford criteria that adds radiographic colonic dilatation and albumin. · PMID 15142197 Note: Derivation cohort was 167 patients at one Edinburgh centre, 1995-2002, entirely pre-biologic. Reported failure rates of 11% / 43% / 85% for scores 0-1 / 2-3 / >=4 have not reproduced in the biologic era. The head-to-head comparison against the Oxford criteria in UK IBD Audit data (PMID 27060985) found neither score performed well enough to govern decisions, and published systematic reviews conclude that none of the day-3 ASUC indices (Oxford, Ho, Lindgren, Seo) is fully validated. Requires a plain abdominal film, which is often not obtained if CT was done instead.

Also on MDCalc

These are established instruments already hosted as free, working calculators by MDCalc. We link them rather than rebuild them. Our own decision-support tools above cover what MDCalc does not, and every link below was verified against MDCalc directly.

• Montreal Classification for IBD live calculatorclassificationAssigns Montreal extent (E1-E3) and severity (S0-S3) for UC, and age / location / behaviour (A, L, B) for Crohn's. Note: A PHENOTYPE classification, not a prediction model. Extent should be recorded as the maximum ever documented, not the most recent endoscopic appearance, which underestimates true extent in quiescent disease.
• Mayo Score / Disease Activity Index (DAI) for Ulcerative Colitis live calculatoractivity indexThe standard UC trial activity index: stool frequency, rectal bleeding, endoscopy subscore and physician global assessment. Note: An ACTIVITY index, not a risk model. The endoscopic subscore requires a scope, so the 'partial Mayo' seen in clinic is a different instrument with different thresholds, say which one you mean.
• Pediatric Ulcerative Colitis Activity Index (PUCAI) live calculatorpaediatricNon-invasive paediatric UC activity score; PUCAI >=65 is the paediatric equivalent trigger for admission in acute severe colitis. Note: PAEDIATRIC ONLY. Do not apply adult Truelove-Witts thresholds to children, or PUCAI to adults.
• Wexner Continence Grading Scale (Cleveland Clinic Incontinence Score) live calculatorfunctional outcomeGrades faecal incontinence 0-20 across solid, liquid and gas leakage, pad use and lifestyle alteration. Note: The single most-used continence instrument after ileal pouch surgery and the one reported in most IPAA functional-outcome series. Note MDCalc's URL slug says 'obstructed defecation syndrome' but the tool served is the Wexner continence scale.
• Surgical Apgar Score (SAS) live calculatorperioperativePost-hoc intraoperative risk score from estimated blood loss, lowest mean arterial pressure and lowest heart rate. Note: Calculated AFTER the operation, so it informs postoperative disposition, never the decision to operate. Not validated specifically in IBD surgery.

Guideline summaries hosted by MDCalc:

• ACG Clinical Guideline: Ulcerative Colitis in Adults (via MDCalc) guidelineMDCalc's structured rendering of the ACG UC guideline. Note: The underlying ACG 2019 full text stores its comparison operators corrupted in our corpus (the published PDF encodes '>' as '.' and '<' as ','), so quote thresholds from MDCalc's rendering or the journal, never from our stored text.
• ACG: Preventive Care in Inflammatory Bowel Disease (via MDCalc) guidelineVaccination, bone health, skin-cancer and cervical-screening recommendations for immunosuppressed IBD patients. Note: Directly relevant before starting biologics or immunomodulators, and a frequent gap in surgical clinics.
• AGA: Pharmacological Management of Ulcerative Colitis (via MDCalc) guidelineAGA medical-therapy recommendations for UC. Note: Medical therapy only. It does not address surgical indications or timing.