Endoscopic Grading of Peptic Ulcer Bleeding

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  • Topic: Peptic ulcer, Gastroenterology, Esophagogastroduodenoscopy
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  • Published : July 12, 2012
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Endoscopic Grading of Peptic Ulcer Bleeding
Forrest classification is a classification of upper gastrointestinal hemorrhage used for purposes of comparison and in selecting patients for endoscopic treatment. -------------------------------------------------

Forrest classification
Acute hemorrhage
* Forrest I a (Spurting hemorrhage)
* Forrest I b (Oozing hemorrhage)
Signs of recent hemorrhage
* Forrest II a (Visible vessel)
* Forrest II b (Adherent clot)
* Forrest II c (Hematin on ulcer base)
Lesions without active bleeding
* -------------------------------------------------
Forrest III (Lesions without signs of recent hemorrhage)
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Application
Forrest classification is instrumental when stratifying patients with upper gastrointestinal hemorrhage into high and low risk categories for mortality. It is also a significant method of prediction of the risk of rebleeding and very often is used for evaluation of the endoscopic intervention modalities[3]. A prospective controlled study  revealed that "Forrest criteria are essential for proper planning of endoscopic therapy and urgent surgery in bleeding peptic ulcers.”

Presence of shock and type 1 bleeding peptic ulcer carries a rebleed risk of 80% and presence of non-bleeding visible vessel predisposes the patient to a 50% risk of further bleed. Ulcer with a clean base (type 3) and ulcers with red or dark blue spots (type 2c) rarely re-bleed during hospitalization. Bleeding peptic ulcer in the posterior duodenal bulb and proximal gastric lesser curve are located near major vessels and are associated with higher re-bleed rates and are more likely to cause death

Predictors of Mortality 

Patient characteristic that have been reported to be associated with increase in mortality are:

Age, onset of bleeding, co-morbidity, hypotension and shock at presentation, fresh bleed in Ryle's tube aspirate, haemoglobin level at presentation and...
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