Truelove and Witts Severity Index for Ulcerative Colitis

Stratifies severity of UC to help symptom monitoring and response to treatment.

Refer to the text below the calculator for more information on this UC disease  stratification tool.


Ulcerative colitis is a chronic condition that manifests in varying degrees of activity and severity. It is crucial for clinicians to swiftly and accurately assess and track symptoms as well as responses to treatments.

The Truelove-Witts classification, established in the 1950s, has long served as the foundation for severity index scoring in ulcerative colitis, eliminating the need for additional endoscopic examinations.


In the original study by Truelove and Witts, remission was defined as 1 to 2 stools a day without blood, no fever, no tachycardia, haemoglobin level normal or returning toward normal, ESR normal or returning toward normal,  patient gaining weight.

Disease activity was divided into 3 categories (mild, moderately severe, or severe) based on these variables.


1Bowel movements per day
2Blood in stool
3Pyrexia Defined as temperature ≥100.04°F (37.8°C)
4Pulse >90 bpm
5Anemia Defined as hemoglobin ≤10.5 g/dL (105 g/L)
6Erythrocyte sedimentation rate, mm/hr
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Index Explained

With ulcerative colitis being a chronic disease that can present at various stages of disease activity and severity, it is important for clinicians to be able to quickly and objectively evaluate and monitor symptoms and response to treatment.

Since the 1950s the Truelove-Witts classification of disease severity has been the basis of severity index scoring in UC, without the requirement for further endoscopic investigations. The 6 item index was first described in the context of a study of the effect of treatment with cortisone in patients with UC.

Index variable Severity of ulcerative colitis
Mild Moderate Severe
Bowel movements per day <4 4 - 5 ≥6
Blood in stool None or no more than small amounts of blood Between mild and severe Visible blood
Pyrexia
Temperature ≥100.04°F (37.8°C)
No No Yes
Pulse >90 bpm No No Yes
Anemia
Hemoglobin ≤10.5 g/dL (105 g/L)
No No Yes
Erythrocyte sedimentation rate, mm/hr ≤30 ≤30 >30

The index has its limitations due to its ambiguous definitions of improvement and worsening and the lack of a numeric severity score that can be tracked over time.

It is applicable to adult patients with chronic inflammatory bowel disease, there is a different disease severity model, the Paediatric Ulcerative Colitis Activity Index (PUCAI) applicable to children and teenagers.

Another popular disease severity tool for UC is the Mayo score, that includes endoscopic findings and an item of physician global assessment and provides a numeric result.

 

Result Interpretation

In the original study by Truelove and Witts, remission was defined as 1 to 2 stools a day without blood, no fever, no tachycardia, haemoglobin level normal or returning toward normal, ESR normal or returning toward normal,  patient gaining weight.

Disease activity was divided into 3 categories (mild, moderately severe, or severe) based on these variables.

Diagnosis is mild severity ulcerative colitis when all six criteria are satisfied with: <4 bowel movements per day, none or no more than small amounts of blood, no pyrexia, pulse ≤90, haemoglobin >10.5 g/dL (105 g/L) and erythrocyte sedimentation rate ≤30 mm/hr.

Diagnosis is severe ulcerative colitis when criteria for frequency of bowel movement (≥6) and ≥1 feature of systemic upset (pyrexia, pulse, anaemia, erythrocyte sedimentation rate) are satisfied.

 

References

Original reference

Truelove SC, Witts LJ. Cortisone in ulcerative colitis; final report on a therapeutic trial. Br Med J. 1955; 2(4947):1041-8.

Other references

Pabla BS, Schwartz DA. Assessing Severity of Disease in Patients with Ulcerative Colitis. Gastroenterol Clin North Am. 2020; 49(4):671-688.


Specialty: Gastroenterology

Objective: Disease severity

Type: Index

No. Of Variables: 6

Year Of Study: 1955

Article By: Denise Nedea

Published On: May 15, 2024

Last Checked: May 15, 2024

Next Review: May 15, 2029