Scores > 10 (or 12 in some studies) suggest a severe flare-up likely to require advanced rescue therapy if not responding to IV steroids.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Daily monitoring of patients hospitalized with Acute Severe Ulcerative Colitis (ASUC)
Research-grade quantification of symptom severity in acute UC trials
Used specifically to track response to intravenous corticosteroids or rescue therapy (Ciclosporin/Infliximab)
Historical Context
The Lichtiger index was the primary outcome measure in the landmark 1994 trial that proved the efficacy of Ciclosporin for steroid-refractory UC. It is often referred to as the "Lichtiger/Modified Truelove and Witts" score.
Section 2
Formula & Logic
The 8 Clinical Items (Score 0–21)
01
Diarrhea (Stool frequency per day).
02
Nocturnal stools (recorded as Yes/No).
03
Visible blood in stool (Amount).
04
Fecal Incontinence.
05
Abdominal pain/cramping.
06
General well-being.
07
Fever (> 37.8°C).
08
Tenderness on palpation.
Total Score Interpretation
Score ≤ 3
Clinical Remission
Score 10–15
Moderate Activity
Score > 15
Severe / Fulminant Activity
Section 3
Pearls/Pitfalls
Responsiveness to Therapy
The Lichtiger index is extremely sensitive to changes in symptoms during hospital stay. A decrease of ≥ 3 points is typically considered a "Clinical Response" in an acute setting.
The Ciclosporin Connection
Most inpatient protocols for intravenous Ciclosporin define success as a drop in the Lichtiger index to < 10 for two consecutive days.
Clinical Pearls
The inclusion of "Nocturnal Stools" reflects the loss of rectal compliance and high nighttime disease activity
Fecal incontinence is a marker of severe rectal inflammation and poor sphincter control in the setting of acute colitis
Developed by Dr. Simon Lichtiger and colleagues at Mt. Sinai Hospital, New York. Mt. Sinai has been a global leader in IBD research since Burrill Crohn described his namesake disease there in 1932.
