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    Patent Pending

    Forrest Classification of Upper GI Bleeding

    Stratifies severity of upper GI bleeding according to endoscopic findings.
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    When to Use
    Pearls/Pitfalls
    Why Use

    Patients with peptic ulcers seen on endoscopy that are or have been bleeding.

    • Standardized classification system for endoscopists to describe peptic ulcers.
    • Reliably risk-stratifies patients with peptic ulcers and predicts risk of rebleeding and/or mortality.
    • Endoscopic appearance of ulceration guides endoscopic therapeutic decision and post-EGD medical treatment/disposition (i.e., admit vs. discharge, level of care, and length of stay).
    • There may be some inter-observer variation in classifying ulcers depending on timing of endoscopy, adequate visualization, vigorous irrigation, and level of training.
    • Since Forrest et al’s seminal study, the advent of proton pump inhibitors and development of endoscopic therapies for peptic ulcer bleeding has dramatically improved outcomes. Etiologies of peptic ulcer disease have also changed (e.g. ubiquity of NSAID use).
    • Helps prognosticate and risk stratify patients based on stigmata of recent hemorrhage and decide on discharge versus close inpatient monitoring.
    • Provides gastroenterologists a system to uniformly and simply classify and describe peptic ulcers.
    Active spurting
    Active oozing
    Non-bleeding visible vessel
    Adherent clot
    Flat pigmented spot
    Clean ulcer base

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    The Forrest Classification should be used to characterize all peptic ulcers, as it provides prognostic information on the need for endoscopic therapeutic intervention, the risk of rebleeding and death.

    Content Contributors
    • Shawn L. Shah, MD
    Reviewed By
    • Carl V. Crawford, MD
    About the Creator
    Dr. John A. H. Forrest
    Are you Dr. John A. H. Forrest?
    Content Contributors
    • Shawn L. Shah, MD
    Reviewed By
    • Carl V. Crawford, MD