Clinical decision support

Practice guidelines and risk calculators

Third-party guidelines and prediction tools relevant to IBD-unclassified, each independently verified against PubMed. These are external documents and tools — linked, not reproduced, and not evidence-gated by this site.

Practice guidelines

• ECCO-ESGAR-ESP-IBUS Guideline on Diagnostics and Monitoring of Patients with Inflammatory Bowel Disease: Part 1 ECCO / ESGAR / ESP / IBUS · 2025 · PMID 40741688 · J Crohns Colitis
  What diagnostic work-up is required before a colitis can be labelled IBD-unclassified, and what further testing (ileocolonoscopy with segmental biopsies, small-bowel imaging, capsule endoscopy) may reclassify it as CD or UC.
• ECCO-ESGAR-ESP-IBUS Guideline on Diagnostics and Monitoring of Patients with Inflammatory Bowel Disease: Part 2 ECCO / ESGAR / ESP / IBUS · 2025 · PMID 40742985 · J Crohns Colitis
  How to monitor an established IBD diagnosis over time, including post-operative assessment and cancer surveillance — the setting in which an IBDu label is most often revised.
• ECCO Topical Review on Pouch Disorders ECCO · 2025 · PMID 40574702 · J Crohns Colitis
  Diagnosis and management of inflammatory, functional, structural and neoplastic J-pouch disorders — the reference for what to expect and how to treat when an IBDu patient has an IPAA. Holubar is a co-author.
• AGA Clinical Practice Guideline on the Management of Pouchitis and Inflammatory Pouch Disorders AGA · 2024 · PMID 38128971 · Gastroenterology
  GRADE-based treatment of pouchitis, Crohn's-like disease of the pouch and cuffitis — 9 recommendations, all conditional. The only fully GRADE-graded pouch guideline.
• Diagnosis and classification of ileal pouch disorders: consensus guidelines from the International Ileal Pouch Consortium International Ileal Pouch Consortium · 2021 · PMID 34416186 · Lancet Gastroenterol Hepatol
  The canonical taxonomy of pouch disorders (structural, inflammatory, functional, neoplastic) used to define endpoints in pouch-outcome studies, including IBDu cohorts.
• Treatment of pouchitis, Crohn's disease, cuffitis, and other inflammatory disorders of the pouch: consensus guidelines from the International Ileal Pouch Consortium International Ileal Pouch Consortium · 2022 · PMID 34774224 · Lancet Gastroenterol Hepatol
  Treatment companion to the classification document above — how to escalate therapy for chronic pouchitis and Crohn's disease of the pouch, the commonest reason an IBDu pouch is re-labelled as CD.
• Clinical Practice Guideline for the Surgical Management of Ulcerative Colitis ASCRS · 2026 · PMID 42165399 · Dis Colon Rectum
  Current ASCRS surgical guideline: staging of colectomy/IPAA, emergency indications, and management of dysplasia/cancer. Table 3 lists what changed vs the 2021 edition. Dis Colon Rectum 2026;69:2012-2039.
• ACG Clinical Guideline Update: Ulcerative Colitis in Adults ACG · 2025 · PMID 40701556 · Am J Gastroenterol
  Current US medical-management guideline for UC, including thresholds for referral to colectomy. Supersedes the widely-cited 2019 Rubin guideline.
• British Society of Gastroenterology guidelines on inflammatory bowel disease in adults: 2025 BSG · 2025 · PMID 40550582 · Gut
  Comprehensive UK guideline covering diagnosis and management of both CD and UC — useful where an IBDu patient must be treated as one or the other. Supersedes the 2019 Lamb guideline.
• ESPGHAN revised Porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents ESPGHAN (Paediatric IBD Porto Group) · 2014 · PMID 24231644 · J Pediatr Gastroenterol Nutr
  The only guideline that sets out explicit positive diagnostic criteria for IBD-unclassified (rather than defining it as a diagnosis of exclusion), and separates typical from atypical UC. Still the reference standard for IBDu classification at any age.
• Management of paediatric ulcerative colitis, part 1: Ambulatory care — An updated evidence-based consensus guideline from ESPGHAN and ECCO ESPGHAN / ECCO · 2025 · PMID 40677018 · J Pediatr Gastroenterol Nutr
  Updates the 2018 paediatric UC guideline and contains dedicated sections on IBD-unclassified and on pouchitis; 39 recommendations plus 77 practice points. Open access.

Risk calculators and prediction tools

• Pouchitis Disease Activity Index (PDAI) formula only — no calculatornot validated18-point composite of clinical symptoms, endoscopic appearance and acute histologic inflammation; score ≥7 defines pouchitis. The instrument that operationally defines the commonest pouch outcome measured in IBDu series. · PMID 8170189 Note: NOT a validated instrument. Derived in 1994 on 25 patients total (10 with pouchitis, 15 controls). A 2022 systematic review of 21 operating-property studies (PMID 34180986) concluded no pouchitis index is fully valid, reliable or responsive; PDAI inter-rater reliability was only fair-to-moderate (kappa 0.44) and clinical subscores correlate poorly with endoscopic/histologic subscores. A separate study found antibiotics benefit many symptomatic patients scoring <7, so the diagnostic threshold misses treatment-responders. There is no official web calculator — no MDCalc entry exists; it must be scored by hand from the published table, and it requires biopsy histology, so it is not a bedside tool.
• Modified Pouchitis Disease Activity Index (mPDAI) formula only — no calculatornot validatedPDAI with the histology subscore dropped (clinical + endoscopic only); score ≥5 defines pouchitis. The practical version usable at the time of pouchoscopy without waiting for pathology. · PMID 12794576 Note: Shares the PDAI's validation problem and is arguably weaker: inter-rater reliability kappa 0.389, i.e. lower than the parent index. Derived by excluding patients with chronic refractory pouchitis AND patients with Crohn's disease — precisely the populations an IBDu pouch is most likely to become, so its performance in IBDu is untested. Reported sensitivity/specificity are against the unvalidated PDAI as reference standard, not against an independent gold standard.