Changelog

Dr. Squirell's review: the C. difficile item now gives the treatment if the test is positive, with oral vancomycin 125 mg four times daily for 10 days first line and fidaxomicin 200 mg twice daily for 10 days as the alternative, because coverage in Canada favours vancomycin. No change to the scoring or the chart note.

Dr. Squirell's review. The thiopurine pregnancy item now leads with the 2025 IBD consensus (continue an established thiopurine through conception, pregnancy and breastfeeding) and mentions the Imuran label only to say it is more restrictive and the consensus should be followed; the label's contraception periods are no longer quoted.

Dr. Squirell's review: thiopurine blood monitoring now leads with the BSG schedule (CBC, creatinine and liver tests at weeks 2, 4, 8 and 12, then at least every 3 months), matching the thiopurine tool. The stricter Imuran monograph schedule (weekly CBC in the first month) is kept as a secondary note.

Dr. Squirell's review. Methotrexate, JAK inhibitors, ozanimod and etrasimod now stop 3 months before trying to conceive (clinic practice: time to switch and confirm remission on the new drug), with the consensus minimum shown alongside, in both the checklist and the patient plan. Folic acid now says to continue it throughout pregnancy on sulfasalazine or with malabsorption (2025 Global Consensus). The thiopurine pregnancy line no longer quotes the Imuran label's contraception periods: it says the label is more restrictive and to follow the IBD consensus.

Dr. Squirell's review: CRP is now listed in the work-up as optional, because Rome V lists it with the initial blood tests while CAG 2019 recommends against routine CRP. It is not added a second time when an alarm feature already lists CRP. The chart note's plan includes it.

Dr. Squirell's review (ASH 2026 thresholds): above a ferritin of 150 µg/L the Diagnose tab now follows BSG 2021, even with inflammation and TSAT below 20%. It says iron deficiency is unlikely and, with anemia, to consider anemia of inflammation and other causes; it no longer shows 'functional iron deficiency' there. At 150 µg/L or below, the ASH 2026 rules are unchanged.

Dr. Squirell's answers applied. Current iron: the treatment range is now 50–150 mg elemental iron a day, so 150 mg once daily (FeraMAX Pd Therapeutic 150, a labelled treatment dose) is no longer called high; BSG 2021's 50–100 mg for most and the ECCO 2015 limit of 100 mg a day in IBD are still shown. Prevent: low intake now points to a daily multivitamin with iron (check the label), or a prenatal multivitamin in pregnancy, instead of iron products; ongoing losses give her clinic practice, one low-dose iron product daily (28–49 mg elemental iron), moving to full treatment dosing if deficiency recurs or Hb or ferritin are not kept stable.

Independent review. Fixed: liquids are now counted in mL throughout (Palafer suspension 20 mg iron per mL, Floradix 1 mg per mL, Fer-In-Sol 15 mg per mL), and picking a product starts at its labelled dose, so typing 5 for 5 mL no longer gives five times the iron. Fixed: the split-dosing warning quoted the 60 mg hepcidin finding (Moretti 2015) for doses under 60 mg (for example Floradix 10 mg twice daily); below 60 mg it now cites only the BSG advice. Fixed: Optifer Alpha is labelled 1 tablet three times daily, not 1 to 3. The Treat tab now says heme iron 11 mg is multivitamin-level iron, as the Current iron tab does, and lists the drugs to separate from oral iron (levothyroxine 4 hours; quinolones, tetracyclines, bisphosphonates and mycophenolate 2–4 hours), as the old tool did. The IV iron button on the Diagnose result carries the Hb across.

One iron tool for clinic, bringing back what the old tool did well. New Prevent tab: a safety gate, Health Canada targets by life stage (with the vegetarian 1.8 factor and the upper limit), and strategies for low intake, ongoing losses, blood donors, bariatric surgery and IBD after repletion. New Current iron tab: search by brand, salt or type, browse, or add a custom product by elemental iron or salt weight; iron per dose, day and week; comparison with treatment dosing or the prevention target; flags such as split dosing. The Treat tab now shows the cost a month, Ontario Drug Benefit status, a copyable prescription, the expected Hb response and when to switch to IV iron, with the ECCO 2024 and 2015 rules for IBD; ferric maltol (Accrufer) added. IV iron adds the monograph pregnancy caps and ideal body weight for Ganzoni in obesity. Corrected from the old tool: 2015 prices and unverified products removed; Palafer capsules are no longer an ODB benefit; vitamin C is no longer suggested with oral iron; prevention targets are total intake, not the supplement dose; the blood-donor regimen is the Canadian Blood Services one.

Dr. Squirell's review. Stop times: methotrexate, JAK inhibitors, ozanimod and etrasimod now stop 3 months before trying to conceive (clinic practice: time to switch to a pregnancy-compatible drug and confirm remission on it), with the consensus minimum shown alongside. Folic acid: at-risk patients (sulfasalazine, extensive small-bowel disease or malabsorption) are told to continue it throughout pregnancy, and the line now shows in every trimester for them (consensus text). The status line now flags active perianal disease (mode-of-delivery discussion; cesarean suggested, GRADE 10) and a previous VTE (thromboprophylaxis assessment with obstetrics), in every stage. Rotavirus now follows the consensus ('may be given'), noting that the more cautious Canadian Immunization Guide advice dates from 2016. The thiopurine line no longer quotes the Imuran label: it says the label is more restrictive and to follow the IBD consensus.

Dr. Squirell's follow-up: the tool opens blank again (no medicine chosen, no taper filled in), and the Use the clinic default button fills prednisone 40 mg daily for 14 days, then down 5 mg every 7 days, with 5 mg tablets. Reset clears everything.

Dr. Squirell's review. The tool now opens on the clinic default: prednisone 40 mg daily for 14 days, then down 5 mg every 7 days (9 weeks, 5 mg tablets); the old default was 40 mg for 7 days. New way to slow a taper: keep the 5 mg steps but reduce every 10 or 14 days once the dose reaches 20 mg (dose adjustable), alongside the existing smaller steps. Pneumocystis advice rewritten in plain language and driven by two questions (immunomodulator; biologics or JAK inhibitors): prophylaxis recommended for triple immunosuppression, otherwise usually not needed, weighing the antibiotic risks, including C. difficile, against how rare the infection is (clinic practice, consistent with ECCO 2026). It no longer triggers on the steroid dose alone. Tablet counts replace the total mg: per day, per step and for the whole course, in the panel and the chart note (a Duration line replaces the total mg line). The printable patient schedule can be a list or a month calendar showing each day's dose and tablets.

Dr. Squirell's review. Monitoring now leads with the BSG schedule (CBC, creatinine and liver tests at weeks 2, 4, 8 and 12, then at least every 3 months); the stricter Imuran monograph schedule is a secondary note. Undetectable 6-TGN with a low but detectable 6-MMP (5700 or less) is now read as likely non-adherence or partial adherence, not shunting: check adherence first, and consider shunting only if adherence is confirmed and a repeat test shows the same pattern. Undetectable 6-TGN with 6-MMP above 5700 is still read as shunting, with an adherence check first.

Currency review. Guideline citations moved from ECCO 2022 to the ECCO 2026 UC medical treatment guideline (same doses; new recommendation numbers). Monitoring now follows BSG 2025 GPS 85 (CBC, renal and liver tests at baseline, 3 months, then yearly). Products re-checked in the DPD (unchanged); notes now mention olsalazine (Dipentum), which is still marketed in Canada, the EASI trial of 1.6 g once daily for maintenance, and BSG 2025 on stopping 5-ASA once in deep remission on advanced therapy.

Currency review against ECCO 2026 (UC medical treatment and infections), BSG 2025 (now read in full) and AGA 2026. Admission checklist: do not add oral 5-ASA to IV steroids (ECCO 2026 Rec 44). Infliximab advice cites ECCO 2026 Rec 46 (no routine intensified dosing; individualised dosing allowed). An improving patient now gets the maintenance plan, with BSG 2025 GPS 43 and ECCO 2026 practice point 1 (not a thiopurine or 5-ASA alone) side by side. Prior anti-TNF failure mentions JAK inhibitors as a specialist option (ECCO 2026 practice point 2). The old blanket 'do not give infliximab and ciclosporin one after the other' is replaced by ECCO 2026 Rec 47 (third-line sequential rescue only in highly selected patients at experienced centres), with the Toronto and BSG positions. JAK wording corrected to the BSG 2025 text. Notes add the ACTIVE trial, the PREDICT-UC level analysis, the 2025 meta-analysis and the 2026 Delphi criteria.

A ticked item now resets when its requirement changes (for example the TB item for vedolizumab alone becomes the stricter anti-TNF item once an anti-TNF is added). Ozanimod: the ophthalmology item is listed only with diabetes, uveitis or retinal disease, as in the Zeposia monograph, so it no longer counts as outstanding when the answer is no. Chart note Ref now cites BSG 2025 and ECCO 2026 instead of BSG 2019.

Currency review. BSG 2019 replaced by the BSG 2025 IBD guideline, and the 2026 ECCO infections guideline (July 2026) added. New EBV IgG item (ECCO 2026 suggests it for everyone; with a thiopurine or anti-TNF it carries the lymphoma caution from ECCO 2026 and BSG 2025). The TB item now says to delay an anti-TNF or JAK inhibitor until at least 3–4 weeks after latent TB treatment has started (ECCO 2026 Statement 20). The vaccine item now points to NACI COVID-19 and RSV advice. Canadian monograph changes added: Imuran (September 2026) contraception for 6 months (women) or 3 months (men) after stopping and routine liver tests (non-cirrhotic portal hypertension); Rinvoq (2025) GI perforation, hypoglycemia and tablet-residue warnings; Velsipity (2025) skin examination for all patients. S1P contraindications for active malignancy and immunocompromise from other therapy are now listed. Teaching notes list where ECCO 2026 and Canadian guidance differ.

MELD-Na and MELD 3.0 are now shown capped at 40 (with the uncapped value when higher), matching the MELD 3.0 tool; the original MELD for the steroid decision stays uncapped. The dialysis hint now gives the allocation definition (two or more sessions, or 24 hours of continuous renal replacement, in the past week) and notes that MELD 3.0 caps creatinine at 3.0 mg/dL. Corrected the statement that MELD 3.0 is context only: Ontario uses MELD 3.0 for transplant referral and listing. The chart note now lists sodium, albumin and sex when entered.

Currency check (October 2026). No new ACG, AASLD, EASL or Canadian guideline on alcohol-associated hepatitis has replaced ACG 2024, so the calculations and steroid rules are unchanged. Added an evidence section on trials published in 2025–26: STASH (tapered prednisolone, fewer infections), CORTISAVE (no clear benefit after early spontaneous bilirubin fall; underpowered), AHFIRM (larsucosterol, negative primary end point) and GPreAH (G-CSF with prednisolone, small single-country trial).

New tool. Independent review before release: after a positive FIT the repeat now reads 'sooner (as soon as possible)' instead of a 3-month figure that could not be checked against the full USMSTF text, and the salvage advice names its sources.

First version. CDAI with day-by-day or summary diary entry, hematocrit in L/L or %, standard weight from height or a table, trial conventions stated, CR-70 and CR-100, and both forms of PRO2 from the same diary. Pre-release review: totals of exactly x.5 now round up reliably (floating-point error had turned 149.5 into 149, remission); baseline PRO2 averages shown in the note; invalid baseline values ignored.

Currency review. Every infliximab result now warns that the targets are for IV infliximab and do not apply to subcutaneous infliximab (Remsima SC, marketed in Canada), whose levels are higher and steady (BSG 2025; Roblin 2022; Iborra 2025). Added ECCO 2026 practice point 7 (insufficient data for proactive TDM in UC; reactive TDM at anti-TNF loss of response) and BSG 2025 GPS 61–62 (insufficient evidence to test vedolizumab or ustekinumab levels) to the results and notes. Added the PREDICT-UC day-3 level data for ASUC and the Canadian infliximab and ustekinumab products (DPD).

New tool. Independent review before release: when the result is low risk, the chart note now records the metabolic risk answer that sets the repeat interval.

Currency check (October 2026): no new Canadian H. pylori guideline since Toronto 2016; Pylera still marketed, vonoprazan and Talicia still not approved, Hp-PAC cancelled, Mycobutin and AA Pharma tetracycline still marketed (Health Canada DPD, 11 October 2026). Added 2025 Canadian susceptibility data from refractory cases in Vancouver (levofloxacin 50%, clarithromycin 13%, amoxicillin and tetracycline 97–99%), which support avoiding empiric levofloxacin after treatment failure.

Chart note: Ref now lists ECCO 2026 (Yanai) whenever the plan quotes the ECCO 2026 infections guideline.

Currency review against the 2026 ECCO infections guideline and 2025–26 evidence. HBsAg-positive patients on a low-risk or unclassified therapy now get prophylaxis as the favoured plan (ECCO 2026 Statement 6 suggests an antiviral for every HBsAg-positive patient before immunosuppression, including steroids), with monitoring as the alternative only if hepatology agrees; AGA tiers are unchanged. Detectable HBV DNA with negative HBsAg now cites ECCO 2026 Statement 7. The anti-TNF low-risk note now gives the 2026 meta-analysis rate (2.3%; 8.2% if anti-HBs negative). Canadian vaccine availability rechecked: Heplisav-B still not available.

Currency review. The 2021 ECCO infections guideline is replaced by the July 2026 update, and the BSG 2025 IBD guideline is added. Cervical screening no longer reports a disagreement with ECCO (ECCO 2026 now advises age-appropriate screening in line with national programmes, not yearly). EBV serology is now part of the baseline screen, and the EBV caution also shows for anti-TNF therapy (BSG 2025). Anti-TNF patients get the ECCO 2026 TB re-screening advice. Patients on methotrexate now get skin-cancer counselling (BSG 2025). The RSV line at 60–64 on immunosuppression notes ECCO's suggestion. Teaching notes now mention the Guillain-Barré syndrome warnings added to the Shingrix, Arexvy and Abrysvo monographs. NACI COVID-19 (October 2026), RSV (April 2026) and pneumococcal (July 2026) guidance rechecked: unchanged.

A hidden 'years since symptom onset' answer left over after choosing PSC = yes no longer affects the result (it could add the paediatric-onset advice) or appear in the chart note.

Currency review. BSG 2025 is still the newest surveillance guideline and the tool's intervals are unchanged. The comparison section now cites the current ECCO position (ECCO-ESGAR-ESP-IBUS diagnostics and monitoring guideline, 2025), which keeps 1-, 2–3- and 5-year intervals and accepts virtual or dye-based chromoendoscopy, and sets out the 2025 HELIOS trial and how BSG and ECCO differ on technique.

Chart note: adds the caution shown on the page that IBUS-SAS was developed and is best validated in Crohn's disease, with early ulcerative colitis data.

Updated to the American Society of Hematology 2026 guideline on diagnosing iron deficiency. Without inflammation, a ferritin of exactly 30 µg/L now counts as iron deficiency (ASH: 30 or lower), and 31–50 µg/L is shown as borderline or possible iron deficiency (ASH: 50 or lower with symptoms or ongoing risk factors) instead of 45 µg/L and above being called 'unlikely' in anemia. With inflammation, the result now says ASH would still consider iron deficiency when TSAT is below 20%, shows where BSG 2021 disagrees above 150 µg/L, and asks for TSAT when it is missing. Added ferric maltol (Accrufer), marketed in Canada since February 2025, to the teaching notes.

New tool. Independent review before release: creatinine and bilirubin entered in mg/dL no longer trigger a false out-of-range warning; the dialysis hint now matches the Ontario policy wording (7 days before the creatinine; 265.2 µmol/L); the MELD 3.0 ≥15 referral line is attributed to AASLD/AST 2025.

New tool. Milan Ultrasound Criteria by segment (worst segment reported), with response against an earlier scan, and the UC-IUS index as a second tab. Pre-release review: BWT kept to 0.01 mm so a mean of three measurements is never rounded across the 6.2 cut-off; MUC shown to three decimals where needed; a 1.0–2.0 mm fall with Doppler signal still present is now indeterminate rather than "not met" (Ilvemark 2022 needs a one-grade Doppler fall); a thicker wall is reported as "up".

First version. Builds the Montreal code for Crohn's disease and ulcerative colitis from plain questions, with an optional Paris paediatric version, plain-language wording and a chart note.

Five or more sessile serrated lesions (including more than 10) now give a reminder to check the serrated polyposis syndrome criteria, in the result and the chart note, whatever the lesion size. A hyperplastic polyp of 10 mm or more (colonoscopy in 3–5 years) now shows the due age as a range (for example 75–77) instead of only the 3-year age.

Currency review. Infant vaccines now include RSV monoclonal antibody (nirsevimab) on the routine schedule after in-utero biologic exposure, as added to the Canadian Immunization Guide (September 2026). The thiopurine preconception advice now flags the more restrictive Canadian Imuran monograph (September 2026: contraception during and for 6 months after treatment in women). Teaching notes add the BSG 2025 position on infant live vaccines (12 months), the 2025 Calgary rotavirus cohort, and 2025–26 pregnancy data for risankizumab and tofacitinib. No recommendation changed: the 2025 Global Consensus is still the current version.

New tool. Original and modified Rutgeerts score with a plan that checks risk factors, current therapy and previous anti-TNF failure. Pre-release review: age risk factor corrected to 30 or younger (Hanzel 2022).

A baseline SES-CD of 0 now shows a clear message in the result and the chart note (a percentage fall cannot be calculated from 0, so endoscopic response cannot be assessed) instead of silently showing no response.

Chart note: the bone, metabolic and escalation advice shown for every course (calcium and vitamin D, fracture risk, over 65 consider an oral bisphosphonate per BSG 2025) is now in the note for budesonide as well as prednisone, as a Plan list. The prednisone prescription line says to take it in the morning with food. Ref lists every guideline the cautions quote. The starting-dose field now accepts up to 100 mg, the range the taper handles (above 60 mg/day still carries a caution).

Currency review against BSG 2025 (read in full), the ECCO 2026 UC and infection guidelines, and a 2026 taper RCT. Pneumocystis advice now follows ECCO 2026 Statement 31 (individualised; strongly consider with triple, consider with double immunosuppression or high-risk features) and also appears when a course gives more than 28 days at 15 mg/day or more. 40 mg courses of 6 to under 8 weeks now note that a 6-week course was inferior to a 10-week course in an RCT (Kumar 2026). Courses over 12 weeks cite ECCO's 3-month limit. Patient copy says to take prednisone in the morning with food (BSG 2025). Bone advice adds BSG 2025 (over 65, consider an oral bisphosphonate). Notes add glucocorticoid-induced adrenal insufficiency and where the guidelines differ.

Currency review. STRIDE-II is still the current IOIBD treat-to-target statement (no STRIDE-III has been published as of October 2026), so targets and Table 4 are unchanged. Teaching notes now add the 2025 ECCO-ESGAR-ESP-IBUS monitoring recommendations (early response check by 12 weeks, including intestinal ultrasound; endoscopic response in CD within 12 months) and where they go further than STRIDE-II on transmural and histological healing.

New tool. Independent review before release: corrected the Simsek 2017 PMID and the BSG 2025 EBV statement number (GPS 26); for mercaptopurine with intermediate TPMT the tool no longer attributes an unconditional 30–80% reduction to CPIC or shows a CPIC range; mercaptopurine with allopurinol cites the mercaptopurine monographs; the high 6-TGN action is no longer attributed wholly to BSG Table 8; undetectable 6-TGN with detectable 6-MMP now prompts an adherence check.

Independent clinical review. When the optional CRP is left blank and A is not met, the result and chart note now say CRP was not measured (a CRP of 10 mg/L or more would meet A-2), so 'criteria not met' is not read as a negative CRP. All criteria, severity thresholds, unit conversions and drainage timings re-checked against TG13/TG18 (Kiriyama 2012 Tables 4 and 7) and ESGE 2019.

Clinical review fixes. Day 3: when few bloodless stools came with a high Lindgren index or Ho score, the band correctly said response was not established but the action list still read 'complete response' and 'switch to oral prednisone once sustained'; it now gives the incomplete-response actions only. Beyond day 7, a patient who is responding is now told to plan the oral switch (BSG 2019: IV therapy beyond 7–10 days adds no benefit) instead of 'decide on rescue therapy or colectomy now', which is kept for non-responders. Abdominal X-ray threshold now reads ≥5.5 cm, matching BSG 2019 Table 5.

Checked against current Canadian sources. Recombinant zoster advice now follows NACI 2025 and the Canadian Immunization Guide (2 doses for every immunocompromised adult 18 or older, second dose at least 4 weeks after the first before therapy) instead of CAG 2021's age split; pneumococcal advice is now one dose of Pneu-C-20 or Pneu-C-21. Anti-TNF boxed warnings corrected (hepatosplenic T-cell lymphoma is boxed for Remicade and Humira, not Simponi). The S1P cardiac question now includes NYHA class III or IV heart failure, which the Zeposia and Velsipity monographs list as a contraindication.

Independent clinical review. Fixed: MELD 51 was labelled 'steroid benefit unlikely', but Arab 2021 still found a survival benefit at MELD 51 (HR 0.72) and none only above 51; ACG 2024 asks for careful weighing of risks and benefits above 50. The MELD-above-50 result now says exactly that (still not a green recommendation).

Clinical review fixes. Target text now says the Cheifetz 2021 ranges mainly refer to proactive TDM and that the AGA 2017 thresholds are for reactive TDM. Adalimumab advice now matches the Canadian Humira monograph (40 mg weekly for a Crohn's flare; no adult UC escalation). Ustekinumab and vedolizumab results now carry ACG 2025 KC 37 (insufficient evidence to recommend measuring these levels). Two citations corrected (Papamichael 2019 St 15; Cheifetz 2021 St 17 and 23 wording).

The rifabutin triple regimen now says that its doses are the Toronto table 2 doses (all twice daily) and that the ACG 2024 regimen it is attributed to uses omeprazole 40 mg, amoxicillin 1000 mg and rifabutin 50 mg three times daily (150 mg twice daily where 50 mg is unavailable, as in Canada).

Checked against the AGA 2025 full text. Vedolizumab is now 'not classified' (AGA: insufficient evidence to assess its risk); it was wrongly given the cytokine/integrin tier (high if HBsAg positive, moderate if anti-HBc only). An unclassified drug combined with a classified one now carries a warning instead of disappearing behind the lower tier. IL-23 inhibitors and upadacitinib are flagged as placed by drug class. The anti-TNF 'treat as moderate' hedge was removed (AGA 2025 Table 6: low). High-risk prophylaxis notes that 12 months is reasonable. Anti-HBs wording now follows AGA.

Independent review. The patient plan told everyone on an immunosuppressive medicine to have an HPV test every 3 years; Ontario's 3-year interval applies only after 3 or more years of continuous or frequent immunosuppressive treatment, so it now says every 5 years from age 25 until then (clinician line reworded to match). The patient plan promised two COVID-19 doses a year to everyone immunosuppressed; NACI limits the second dose to people who are moderately to severely immunocompromised, so it now says a second dose may be needed.

Independent review against the BSG 2025 full text and Figures 3, 4 and 6. Added the BSG special circumstance for IBD diagnosed before age 18 (consider surveillance every 1–3 years from transition to adult care; the tool previously said only "baseline at 8 years"), and two calculator exclusions stated by the Oxford tool (paediatric-onset IBD; prior high-grade dysplasia or cancer).

Fixed a stale-answer bug: if a frequency was chosen and the answer was then changed to 'Neither' pain nor discomfort, the hidden frequency still appeared as a reason in the result and chart note. The teaching notes now also say that Rome V lists CRP among the tests for all patients.

Corrected IUS response at exactly 25%: floating-point rounding made some falls of exactly 25% (for example 4.4 to 3.3 mm) count as 'more than 25%'. The tool now compares in tenths of a millimetre. Corrected the description of the 2025 trial-consensus response definition (a smaller BWT fall combined with a fall of one grade in Doppler or another parameter, not a 25% fall in Doppler).

Independent clinical review. Fixed: a ferritin of exactly 150 µg/L with inflammation and low TSAT was called 'above 150' with absolute deficiency unlikely; BSG 2021 applies that only above 150 µg/L. Ferinject, Monoferric and Venofer doses re-checked against the current Canadian monographs (27 June 2024, 29 January 2025, 14 February 2023).

A baseline total entered on one tab (full Mayo, 0–12) was kept when switching to the other (modified Mayo, 0–9) and used for clinical response, comparing scores on different scales. Each version now keeps its own baseline total.

The draining-fistula prompt no longer calls the disease active on patient-reported discharge alone. Losco 2009 counted visible drainage (or induration with pain) on examination as active, so the tool now asks you to check for drainage on examination.

Fixed the stop-age edge: a test due at 85 and a half (for example a 6-month site check at 85) was labelled 'over 85, strongly recommended against'. Ontario's cut-off is age 86 and over, so it is now shown as an individual decision (75–85).

Independent clinical review against the consensus full text. Methotrexate and breastfeeding now includes the consensus condition of no feeding in the 24 hours after a low-dose weekly dose; the postpartum flare rate (14–32%) is now attributed to Squirell 2024 only; an unverified claim that there are no human pregnancy data for mirikizumab or guselkumab was removed. Notes added on phthalate-coated mesalamine and on the 3-month washouts in Squirell 2024.

Clinical review fix. The printed patient instructions now follow the Canadian monographs: Cortiment in the morning, preferably after breakfast, swallowed whole with water (the old text omitted the food advice); Entocort in the morning before breakfast, swallowed whole with water. Added BSG 2019's advice on stopping budesonide to the notes.

Clinical review: Table 4 re-checked against the published paper (all values correct). Fixed the quotation of the Table 4 footnote ('should be considered merely as a rough estimate of experts' opinion'), labelled the CRP column as CRP/ESR as in the paper, and noted where Figure 2 and the recommendation text disagree on the timing of CRP and growth.

Rebuilt. Products re-checked against the Health Canada DPD (21 marketed products; ZDS-Mesalamine suppositories added). Every sig is now built from a fixed regimen (product, units, frequency), so a changed dose can no longer print a nonsensical prescription; every product/dose combination is tested. Fixed sulfasalazine (was 2 g twice daily; now 1 g three or four times daily for induction with gradual start, night interval, monitoring and G6PD check); Salofalk tablets now 3–4 g/day in divided doses; Mezavant once daily only; once-daily use of divided-dose products is labelled as outside the monograph. PODIUM corrected (Dignass 2009 - 70.9% vs 58.9%, P = .024; once daily superior). Added safety stops for severe renal or hepatic impairment and allergy, extent-specific guidance, quantities, and a chart note.

Rebuilt. Fixed: fever was counted at 38.0 °C; TG18 requires above 38 °C. The albumin lower limit of normal is no longer fixed at 35 g/L: enter your lab's value. Added drainage within 12 h for septic shock (ESGE 2019, verified), the ASGE 48-hour target for moderate cholangitis, antibiotic duration, a warning as soon as Grade III is certain, and a chart note. No diagnosis or grade shows until the needed items are answered.

Rebuilt. Fixed the critical error where any day-3 patient who missed the Travis criteria was labelled 'response to steroids – switch to oral prednisone'; missing Travis now says response is not established and incomplete improvement still needs a rescue discussion. Day 1 now requires visible blood and accepts CRP >30 mg/L (modified criteria). Added a sourced admission checklist with the pre-rescue TB, HBV, HCV, HIV and VZV screen, ciclosporin safety checks (prior thiopurine failure, low cholesterol or magnesium, renal function, blood pressure), PREDICT-UC wording for intensified infliximab, Lindgren and Ho indices with non-overlapping stool bands, timing warnings, and chart notes.

New tool.

Rebuilt. Fixed: a green 'Start steroids' showed for MELD 25–39 with no contraindication check; now steroids are only recommended after the clinician answers No to active infection, uncontrolled GI bleeding, kidney injury and uncontrolled diabetes and confirms the diagnosis, and MELD above 50 is flagged. Fixed: the control PT silently defaulted to 12 s; it is now required. Lille cut-off is consistently 0.45 or more, with a day 4 or day 7 choice. Added MELD-Na and MELD 3.0 (context only), unit switches and chart notes. Removed an unsourced 'DF above 90' statement.

New tool.

Rebuilt after a safety audit. Fixed: an incomplete form (for example Hb entered without sex) was scored as normal and labelled very low risk; tapping No on a yes/no item switched that item on. Now no score shows until every item is answered, each answer is explicit, and a score of 0–1 only suggests outpatient care after the clinician confirms no instability, no ongoing bleeding and no other reason to admit. Added a BUN (mg/dL) option, a points breakdown and a chart note. Transfusion thresholds are now attributed correctly (70 g/L ACG 2021; 80 g/L International Consensus 2019).

Rebuilt as an interactive, accessible selector replacing the image-only quick reference. Added the missing test of cure for everyone (at least 4 weeks after treatment, PPI stopped 2 weeks before), the ACG 2024 caution against empiric levofloxacin, the rifabutin restriction (Toronto: after 3 failed options; Canadian access and tuberculosis warnings), penicillin-allergy handling and delabelling, pregnancy and breastfeeding, Canadian availability (Pylera marketed since December 2025; vonoprazan not approved), prescriptions with quantities, and a chart note. PAC and PMC are no longer shown as one ambiguous row, and the Pylera label duration (10 days) is now stated next to the guideline duration (14 days).

Rebuilt. The stool count is now required (the old tool treated a blank as 0 and could show "Remission") and must be a whole number. Complications need an explicit yes or no. Added response against a baseline (fall of 3 or more), full references, the limits of the score, and a chart note.

Rebuilt. Low-risk monitoring now includes HBV DNA as well as ALT every 1–3 months (the old tool said ALT with optional HBV DNA). Heplisav-B removed (not available in Canada); vaccination now uses Engerix-B or Recombivax HB with immunocompromised dosing and post-vaccination anti-HBs. Moderate risk now defaults to prophylaxis, with monitoring as the shared-decision alternative. 'Mandatory prophylaxis' for every HBsAg-positive patient replaced by the AGA tiers plus hepatology referral. Several drugs can be selected (the highest tier wins, with a combination warning). Added IL-23 inhibitors, upadacitinib, S1P modulators (not classified by AGA) and steroid dose and duration. Prophylaxis duration follows AGA wording (at least 6 months; 12 after B-cell depletion).

Rebuilt. Fixed - patients on etrasimod or methotrexate were told "most IBD meds are safe" in pregnancy (pregnancy text now comes drug by drug from the 2025 Global Consensus); HBV and TB screening were marked "not required" for azathioprine and methotrexate (now required before any immunosuppression); Shingrix was limited to 50+ or JAK inhibitors (now all immunocompromised adults 18+); pneumococcal was "every 5 years" (now one dose of Pneu-C-20 or Pneu-C-21); the ustekinumab interval was ignored (now printed as chosen and checked against the Canadian monograph); upadacitinib 30 mg at 65+ is flagged; HPV vaccination separated from cervical screening; skin-cancer advice limited to thiopurines and anti-TNF. Added RSV and COVID-19 guidance, live-vaccine intervals, Ontario HPV-based cervical screening, bone, mood and smoking items, a chart note and a printable patient plan.

Rebuilt on BSG 2025 (East et al.). Fixed - healed left-sided UC and limited Crohn's colitis were given 3-yearly colonoscopy (now 10-yearly reassessment plus population screening when no risk factors, as BSG states); invisible HGD or multifocal LGD went straight to surgery (now a confirmatory high-definition chromoendoscopy within 3–6 months first, and colectomy only if confirmed); switching lesion type kept a stale "incomplete resection" answer (state is now reset and stale answers are ignored). Added the multivariate calculator thresholds, the indefinite-for-dysplasia pathway, pouch and retained-rectum surveillance, age-75 discussion, inadequate-preparation warning, next due date and chart notes. Removed an AGA 5-year interval that had been mixed into a BSG result.

Rebuilt on the Rome V criteria (Gastroenterology 2026), with Rome IV shown alongside so you can see what changed (discomfort counts, 3 days a month, not continuous). Fixed the CAG 2019 rifaximin statement: CAG made no recommendation for or against it, not a recommendation against. Added the CAG 2019 positions on calprotectin, CRP and colonoscopy, the colorectal screening check at 45–74, Canadian drug availability, a stool-diary subtype calculator, a drawn Bristol scale (no external image) and a chart note. No result shows until every item is answered, and any alarm feature holds the diagnosis.

New tool.

Rebuilt. Fixed: Ferinject doses were calculated with Ganzoni, under-dosing many adults (for example 1,076 mg instead of the Canadian monograph's 1,500 mg for 80 kg and Hb 120 g/L); Ferinject and Monoferric now use their own Canadian monograph tables and per-dose caps, with Ganzoni for iron sucrose. Fixed: Hb at or above target returned no dose; it now gives the 500 mg stores. Removed unverified drug-plan coverage claims. Added ferritin interpretation with and without inflammation, a short list of Canadian oral products with labelled elemental iron, a hypophosphatemia warning and chart notes.

Clinical response is no longer shown as "not met" when the rectal bleeding subscore is still 2 or more and the baseline bleeding subscore was left blank; the tool now asks for it. Source label corrected (the FDA guidance is a 2022 draft).

Rebuilt. Remission now also requires no subscore above 1. Added the modified Mayo score, endoscopic improvement and remission, clinical response against a baseline, and a chart note. No result shows until every item is answered.

Rebuilt. Fixed: hypotension (SBP below 90) could still show 'safe discharge candidate'. Now a shock index above 1 or SBP below 90 always gives the unstable pathway, and discharge also needs the clinician to confirm the bleed has stopped and there is no other reason to admit. Removed a 'heart rate ≥110 = unstable' rule that a previous edit added: it is not part of the score or of BSG guidance (BSG defines instability by shock index); a heart rate of 110 or more still scores 3 points. Removed an unsourced score-by-score probability table. Added shock index, a points breakdown and a chart note.

Rebuilt. Gross fluctuance or abscess now always reads as possible perianal sepsis, whatever the total (the old tool could say "inactive, continue maintenance" next to an abscess). Removed the invented severity bands and the unvalidated "≥50% fall = response"; only the PDAI >4 cut-off (Losco 2009) is used. Fixed the reversed statement about clinical and MRI healing. Corrected the darvadstrocel information (EU authorisation withdrawn in December 2024; ADMIRE CD II negative; never marketed in Canada). Nothing shows until all five items are scored. Added a chart note.

Rebuilt on the March 2026 Ontario Health provider tool and the 1 July 2026 ColonCancerCheck changes. Family history now follows the 2026 rules (one first-degree relative diagnosed at 60 or older is average risk; increased risk means colonoscopy every 5 years), replacing the old 10-year colonoscopy branch. Stop ages now follow Ontario (74, 75–85 individualized, over 85 not recommended). Fixed the Cross 2020 misquote: surveillance did reduce cancer incidence in low-risk patients. Added counts of adenomas and serrated lesions, hyperplastic polyps by size and site, preparation, completeness and resection, the next step after each exam, and a source label on every rule. No result shows until every item is answered.

Rebuilt on the 2025 Global Consensus with certainty labels. Fixed - live MMR and varicella were advised before conception even on biologics, thiopurines or steroids (now only if not immunosuppressed, with serology and treatment-gap intervals); a blank due date silently became 12 weeks (now required, with date checks); rotavirus advice was stated as "permitted" (now sets the consensus beside the Canadian Immunization Guide); VTE prophylaxis was "required" (now "consider", plus in-hospital prophylaxis); methotrexate washout was inconsistent; folic acid gave the wrong reason for methotrexate. Added a medicine card for every drug class, breastfeeding mode, intestinal ultrasound reliability by gestation, a chart note and a printable patient summary.

Rebuilt. Each segment can now be marked "Not reached"; it is left out of the total and the result says the score is partial and which segments are missing (the old tool scored unexamined bowel as 0). Nothing shows until every segment is answered (the old page showed "0 – Remission" before any input). Added checks for contradictory entries and for segments marked as seen beyond a narrowing that cannot be passed, STRIDE-II endoscopic healing, endoscopic response against a baseline, sources and a chart note.

New tool.

Rebuilt. The old fixed windows (under 2 weeks, 3 months, 6 months, over 12 months) were not from STRIDE-II and have been replaced by STRIDE-II Table 4, transcribed from the paper. Clinical remission is now kept as a target alongside endoscopic healing, and growth is a target in children. Added IL-23 inhibitors (risankizumab, mirikizumab, guselkumab), upadacitinib, S1P modulators (ozanimod, etrasimod), golimumab and ustekinumab in UC, clearly labelled as having no STRIDE-II timeline, with their pivotal-trial assessment points. Each target now needs an explicit answer, and the result is a dated checklist with a chart note.

Rebuilt. Nothing shows until all three descriptors are scored (the old page showed "0 – Remission" before any input). Removed the claim that every patient with UCEIS ≥7 needs colectomy, which cited a paper that could not be found; the acute severe colitis figures now come from Corte 2015. Removed vedolizumab-only data (Yan 2023) that had been applied to all patients. Endoscopic healing (UCEIS ≤1) is now attributed to STRIDE-II. Bands are labelled as a convention. Added a chart note.

First version.

First version.

First version.

First version.

First version.

First version.

First version.

First version.

First version.

First version.

First version.

First version.

First version.

First version.

First version.

First version.

First version.

First version.

First version.

First version.