GI Scores and Calculators

GI NOTES

GI Scores and Calculators

Key points

Scores support decisions; they never replace clinical judgment.
Know what each score predicts (death, need for intervention, response to treatment) and the cut-offs that change management.
Use a validated calculator for formula-based scores (MELD 3.0, Maddrey, Lille, FIB-4) rather than computing by hand.
This page is a quick reference; follow the linked topic notes for full management.

1. GI bleeding

Score	Inputs	Use it for
Glasgow-Blatchford (GBS)	BUN, hemoglobin, systolic BP, pulse, melena, syncope, liver disease, heart failure	Upper GI bleeding before endoscopy. GBS 0 to 1: very low risk, may be managed as an outpatient.
Rockall (complete)	Age, shock, comorbidity, endoscopic diagnosis, stigmata	Risk of death and rebleeding after endoscopy
AIMS65	Albumin under 3.0, INR above 1.5, altered mental status, systolic BP 90 or less, age 65 or more	In-hospital death in upper GI bleeding
Oakland	Age, sex, prior lower GI bleed, rectal exam blood, pulse, systolic BP, hemoglobin	Lower GI bleeding. Score 8 or less: safe discharge likely.
Forrest classification	Ulcer appearance at endoscopy	Ia/Ib active bleeding and IIa visible vessel: treat endoscopically. IIb clot: consider removal. IIc and III: low risk.

2. Liver disease severity

Score	Inputs	Key cut-offs
Child-Pugh	Bilirubin, albumin, INR, ascites, encephalopathy	A (5 to 6), B (7 to 9), C (10 to 15). Used for drug dosing, surgical risk and early TIPS in variceal bleeding (C 10 to 13, or B above 7 with active bleeding).
MELD 3.0	Bilirubin, INR, creatinine, sodium, albumin, sex	Predicts 90-day mortality; used for transplant allocation in the United States since 2023. Refer for transplant evaluation at MELD 15 or more.
MELD-Na	Bilirubin, INR, creatinine, sodium	The previous allocation score; still widely reported.

3. Alcohol-associated hepatitis

FIGURE: USING SCORES IN SEVERE ALCOHOL-ASSOCIATED HEPATITIS

Day 0: MELD above 20 (or Maddrey 32 or more) = severe

Exclude infection, GI bleeding and kidney failure; start prednisolone 40 mg daily if appropriate

Day 7 Lille under 0.45: responder, continue to 28 days

Day 7 Lille 0.45 or more: non-responder, stop steroids, consider transplant referral

Original diagram based on the ACG 2024 alcohol-associated liver disease guideline.

4. Pancreatitis

Score	Inputs	Meaning
BISAP	BUN above 25 mg/dL, impaired mental status, SIRS, age over 60, pleural effusion	3 or more: higher mortality and organ failure risk
Revised Atlanta	Organ failure duration and complications	Mild, moderately severe, severe (organ failure over 48 hours)
Modified Marshall	Respiratory, renal, cardiovascular function	Score 2 or more in any system = organ failure

5. Inflammatory bowel disease

Score	Used for	Key cut-offs
Truelove and Witts	Acute severe ulcerative colitis	6 or more bloody stools a day plus one sign of systemic toxicity (pulse above 90, fever above 37.8 °C, Hb under 10.5 g/dL, ESR above 30)
Mayo endoscopic subscore	UC mucosal activity	0 normal, 1 mild, 2 moderate, 3 severe (ulceration, spontaneous bleeding). 0 to 1 = endoscopic remission.
Harvey-Bradshaw Index	Crohn’s disease clinical activity	Under 5 remission; 5 to 7 mild; 8 to 16 moderate; above 16 severe
SES-CD and Rutgeerts	Crohn’s endoscopic activity; post-operative recurrence	Rutgeerts i2 or higher suggests recurrence and need to step up therapy

6. Fibrosis and endoscopy

FIB-4 (age, AST, ALT, platelets): under 1.3 low risk of advanced fibrosis; above 2.67 high risk. Use 2.0 as the lower cut-off in people 65 and older. Indeterminate results go to elastography.
Liver stiffness (elastography): under 8 kPa rules out advanced fibrosis in MASLD; 15 kPa or more suggests compensated advanced chronic liver disease. Baveno VII: stiffness under 20 kPa with platelets above 150,000 can avoid screening endoscopy for varices.
Boston Bowel Preparation Scale: 0 to 3 for each of 3 colon segments; total 6 or more with every segment 2 or more is adequate for standard surveillance intervals.
Prague C and M criteria: describe the length of Barrett’s esophagus (circumferential and maximum extent).
Los Angeles classification: grades erosive esophagitis A to D; LA C or D confirms GERD.

Self-check questions

A patient with melena has a Glasgow-Blatchford score of 0. What does this suggest?
What does a day-7 Lille score of 0.6 mean?
FIB-4 is 1.8 in a 50-year-old with MASLD. Next step?
Which score predicts safe discharge in lower GI bleeding?

Answers: (1) Very low risk; outpatient management may be possible. (2) Non-response to steroids; stop them and consider transplant referral. (3) Indeterminate; get elastography. (4) The Oakland score (8 or less).

References

Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am J Gastroenterol. 2021;116(5):899-917.
Kim WR, Mannalithara A, Heimbach JK, et al. MELD 3.0: The Model for End-Stage Liver Disease Updated for the Modern Era. Gastroenterology. 2021;161(6):1887-1895.
Jophlin LL, Singal AK, Bataller R, et al. ACG Clinical Guideline: Alcohol-Associated Liver Disease. Am J Gastroenterol. 2024;119(1):30-54.
de Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno VII – Renewing consensus in portal hypertension. J Hepatol. 2022;76(4):959-974.
Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;77(5):1797-1835.

For educational purposes only. This note does not replace clinical judgment or local protocols. Check doses against current labeling and institutional guidance.