🩸 Forrest Classification (UGI Bleed)
Classify peptic ulcer bleeding endoscopically and estimate rebleed risk (Forrest).
High-risk stigmata (Ia–IIa) need endoscopic haemostasis + IV PPI.
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When to use
Guide endoscopic therapy and PPI strategy in ulcer bleeding.
How it works
Ia spurting / Ib oozing / IIa visible vessel (high risk); IIb clot (intermediate); IIc flat spot / III clean base (low risk).
Key points
- High-risk stigmata (Ia–IIa) need endoscopic haemostasis + IV PPI.
- Low-risk lesions: oral PPI, early feeding/discharge.
- Adherent clot (IIb): consider removal and treat the lesion.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Endoscopic appearance | Ia — active spurting |
|---|
→Forrest IaIa active spurting
- Rebleed risk：~55% rebleed without therapy — high risk
- Management：Endoscopic haemostasis + IV PPI.
| Endoscopic appearance | III — clean ulcer base |
|---|
→Forrest IIIIII clean base
- Rebleed risk：~5% — low risk
- Management：No endoscopic therapy; oral PPI, early feeding/discharge.
Frequently asked questions
- What is Forrest Classification (UGI Bleed)?
- Classify peptic ulcer bleeding endoscopically and estimate rebleed risk (Forrest).
- How is Forrest Classification (UGI Bleed) calculated? What is the core formula?
- Ia spurting / Ib oozing / IIa visible vessel (high risk); IIb clot (intermediate); IIc flat spot / III clean base (low risk).
- When is Forrest Classification (UGI Bleed) used?
- Guide endoscopic therapy and PPI strategy in ulcer bleeding.
- What are the key clinical points for Forrest Classification (UGI Bleed)?
- High-risk stigmata (Ia–IIa) need endoscopic haemostasis + IV PPI. Low-risk lesions: oral PPI, early feeding/discharge. Adherent clot (IIb): consider removal and treat the lesion.
- What are the limits and cautions when using Forrest Classification (UGI Bleed)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is Forrest Classification (UGI Bleed) calculated in practice? Can you show a worked example?
- Inputs: Endoscopic appearance Ia — active spurting → Result: Forrest Ia Ia active spurting（Rebleed risk: ~55% rebleed without therapy — high risk, Management: Endoscopic haemostasis + IV PPI.） Inputs: Endoscopic appearance III — clean ulcer base → Result: Forrest III III clean base（Rebleed risk: ~5% — low risk, Management: No endoscopic therapy; oral PPI, early feeding/discharge.）