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 the ileal pouch, each independently verified against PubMed. These are external documents and tools, linked, not reproduced, and not evidence-gated by this site.
Read the access and validation labels. Very few published IBD prediction tools are simultaneously a live free calculator, externally validated, and validated for the decision you are about to make. Where a tool is formula-only, or was validated only in its derivation cohort, that is stated rather than hidden behind a link. 2 further item(s) found by this review are withheld pending clinician sign-off rather than published unverified.
Practice guidelines
- ECCO Topical Review on Pouch Disorders
- AGA Clinical Practice Guideline on the Management of Pouchitis and Inflammatory Pouch Disorders
- Diagnosis and classification of ileal pouch disorders: consensus guidelines from the International Ileal Pouch Consortium
- Treatment of pouchitis, Crohn's disease, cuffitis, and other inflammatory disorders of the pouch: consensus guidelines from the International Ileal Pouch Consortium
- Management of pouch neoplasia: consensus guidelines from the International Ileal Pouch Consortium
- ECCO Guidelines on Therapeutics in Ulcerative Colitis: Surgical Treatment
- Clinical Practice Guideline for the Surgical Management of Ulcerative Colitis
- ACG Clinical Guideline Update: Ulcerative Colitis in Adults
- British Society of Gastroenterology guidelines on inflammatory bowel disease in adults: 2025
- British Society of Gastroenterology guidelines on colorectal surveillance in inflammatory bowel disease
- Treatment and prevention of pouchitis after ileal pouch-anal anastomosis for chronic ulcerative colitis (Cochrane Review, CD001176, version 5)
Risk calculators and prediction tools
- Atlantic Pouchitis Index (API) Note: Genuinely externally validated (developed on 98 patients from an alicaforsen RCT, externally validated against EARNEST vedolizumab trial data; intra-rater ICC 0.88, inter-rater ICC 0.72, responsiveness AUROC 0.95). BUT: developed entirely in CHRONIC ANTIBIOTIC-REFRACTORY pouchitis clinical-trial populations, so generalisability to unselected clinic patients is unestablished. It requires central-quality video endoscopy scoring plus histopathology, a trial instrument, not a bedside score. No calculator interface exists; no guideline has adopted it yet. Open access CC-BY at the publisher. Year note: online 16 Jul 2025, CGH print issue 2026.
- Pouchitis Disease Activity Index (PDAI) Note: The de facto trial standard (used in 12 of 18 pouchitis RCTs) but NOT a validated instrument. A systematic review (PMID 34180986) concluded existing pouchitis indices are not valid, reliable or responsive. Inter-rater reliability only fair (κ=0.44). Clinically important: a sub-threshold score does NOT exclude treatable pouchitis, 12 of 70 symptomatic patients with PDAI <7 responded to antibiotics (PMID 19882318). The ≥7 cut-off was set arbitrarily. Requires histology, so it delays decisions. NAME-COLLISION WARNING: 'PDAI' also means Pemphigus Disease Area Index, the online 'PDAI calculators' that surface on search are the dermatology score, not this one. No free pouchitis PDAI calculator exists; the item grids are reproducible from open clinicaltrials.gov protocol appendices.
- Modified Pouchitis Disease Activity Index (mPDAI) Note: Faster and cheaper than PDAI with reported AUROC 0.995 against it, but it was validated only against the PDAI itself, which is a non-validated reference standard, not against any external outcome. Inter-rater reliability is worse than PDAI (κ=0.389). The threshold DIFFERS from PDAI (≥5 vs ≥7): mixing the two cut-offs is a common charting and audit error, so any page presenting both must label which index a number belongs to. Patients with chronic refractory pouchitis still need histology to exclude other diagnoses.
- Pouch Functional Score (PFS) Note: Derived and internally validated against the Cleveland Global Quality of Life score in 4,013 patients over 13,105 follow-up episodes, large, but single-institution and never externally validated. Correlation with CGQL is only moderate (rs = −0.47), so it explains a minority of QoL variance; do not present it as a QoL measure. It measures present function and predicts nothing. Conceptually overtaken by the PROPS Delphi consensus core outcome set (PMIDs 33914449, 33938531), which defined 7 bowel symptoms + 7 consequences that pouch studies should report but did NOT produce a scored, validated instrument, so there is currently no validated PROM for routine pouch function.
- Colectomy Risk Score (CRS) repurposed for pouchitis prediction Note: OFF-LABEL REPURPOSING. The CRS was derived to predict need for colectomy in UC, not pouchitis, and this is a single-centre retrospective application. 168 Japanese patients with only 37 pouchitis events over median 7.2 years: badly underpowered for a 3-stratum model, and no external validation for this indication. Reported 5-year pouchitis incidence 10.3% / 18.3% / 36.1% across low/intermediate/high. Report as hypothesis-generating; it is not fit for individual preoperative counselling. Included here only because a clinician may encounter it cited as a pouchitis risk tool.
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 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.
- Wexner Continence Grading Scale (Cleveland Clinic Incontinence Score) 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) 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: Preventive Care in Inflammatory Bowel Disease (via MDCalc) Note: Directly relevant before starting biologics or immunomodulators, and a frequent gap in surgical clinics.