Modified Truelove & Witts • Ulcerative Colitis Activity
Lichtiger Score
0
Clinical Context
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
Verified
Last Review: 2026-07-17
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.
How it Works
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 |
Clinical Pearls
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
Unlike the Mayo score, the Lichtiger index can be calculated daily without endoscopy
Next Steps
Management Action
01
Score > 10 after 3 days of steroids: High risk of failure; consider rescue therapy.
02
Score < 10 and falling: Continue medical therapy; consider transition to oral meds.
The Evidence
The Landmark Study
Cyclosporine in severe ulcerative colitis refractory to steroid therapy.
Lichtiger S et al. • New England Journal of Medicine. 1994;330(26):1841-5. Establishing the index in the context of rescue therapy.
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Origins & History
Simon Lichtiger
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.
Last Comprehensive Review: 2026-07-17