Intest Res  
Are Truelove and Witts criteria for diagnosing acute severe colitis relevant for the Indian population? A prospective study
Saransh Jain1, Saurabh Kedia1, Sawan Bopanna1, Dawesh P Yadav1, Sandeep Goyal1, Peush Sahni2, Sujoy Pal2, Nihar Ranjan Dash2, Govind Makharia1, Simon P.L. Travis3, Vineet Ahuja1
Departments of 1Gastroenterology and 2Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India, 3Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
Correspondence to: Vineet Ahuja, Departments of Gastroenterology, All India Institute of Medical Sciences, Room No. 3093, 3rd Floor, Teaching Block, New Delhi 110029, India. Tel: +91-11-26593300, Fax: +91-11-2658663, E-mail: vineet.aiims@gmail.com
Received: July 21, 2017; Revised: August 26, 2017; Accepted: August 29, 2017; Published online: November 27, 2017.
© Korean Association for the Study of Intestinal Diseases. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background/Aims: Truelove and Witts criteria have been used to define acute severe colitis since the 1950s. However, hemoglobin (an additional criterion of the definition) levels in the general population in developing countries are lower than in the population of developed countries. We aimed to determine the relevance of Truelove and Witts criteria in the Indian population. Methods: Consecutive patients with acute severe colitis satisfying the Truelove and Witts criteria, hospitalized at a single center between April 2015 and December 2016 were included. All patients received intravenous corticosteroids and 16 required colectomy. The hemoglobin levels at admission were subsequently excluded from the classification criteria, and the effect this had on the criteria for diagnosis was determined. Results: Out of 61 patients of acute severe colitis diagnosed according to the original Truelove and Witts criteria, 12 patients (20%) had 1 additional criterion, 33 (54%) had 2 additional criteria and 16 (26%) had 3 or more additional criteria in addition to 6 or more blood stained stools on admission. On excluding hemoglobin as an additional criterion from the Truelove and Witts definition, all patients still met the criteria for acute severe colitis. Conclusions: Truelove and Witts criteria can be used to define acute severe colitis in India, despite lower mean hemoglobin in the native population.
Keywords: Acute severe colitis; Definition; Anemia; Truelove and Witts criteria; India


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