Intended for Healthcare Professionals
You are here
Home > Medical Calculator > Forrest classification – Risk stratification of UGIB

Forrest classification - Risk stratification of UGIB

The Forrest classification system of upper gastrointestinal hemorrhage is used for purposes of comparison and in selecting patients for endoscopic treatment.

Please select the Forrest classification that best describes the current bleeding peptic
ulcer activity
:

Type 1: Acute hemorrhage / Active bleed:
Forrest I a (Spurting hemorrhage)
Forrest I b (Oozing hemorrhage)

Type 2: Signs of recent hemorrhage:
Forrest II a (Non bleeding Visible vessel)
Forrest II b (Adherent clot)
Forrest II c  (Flat pigmented haematin on ulcer base)

Type 3: Lesions without active bleeding:
Forrest III (Lesions without signs of recent hemorrhage or fibrin-covered clean ulcer base)


Background Info

Utilizing the Forrest classification in clinical practice:  

The Forrest classification is vital when stratifying patients with upper gastrointestinal hemorrhage into risk categories that are then used to guide continued therapy and help predict the rebleeding risk and the incidence of death based on the endoscopic findings. 


Please review:


Heldwein W, Schreiner J, Pedrazzoli J, Lehnert P.  Is the Forrest classification a useful tool for planning endoscopic therapy of bleeding peptic ulcers?  Endoscopy. 1989 Nov;21(6):258-62.   https://www.ncbi.nlm.nih.gov/pubmed/2693077

Abstract:
A prospective controlled study was carried out to determine the validity of the Forrest classification in terms of improved laser therapy. Out of 153 consecutive patients with bleeding peptic ulcers, 137 patients--74 with arterial ulcer bleeding and 63 with non-arterial ulcer bleeding--were included in the trial. In arterial ulcer bleeding a significantly lower rate of permanent hemostasis was achieved, and the frequency of urgent surgery and mortality was higher than in non-arterial ulcer bleeding. Patients with spurting arterial bleeding (Forrest Ia) and those with large non-bleeding visible vessels (Forrest IIa) include almost all patients at risk of further bleeding and death. Combined laser therapy clearly minimizes the risk of rebleeding and death in small non-bleeding visible vessels (Forrest IIa). In contrast, decreased hemoglobin and a requirement for blood transfusion are of limited prospective value for the individual emergency patient. Overall, our results demonstrate that Forrest criteria are essential for proper planning of endoscopic therapy and urgent surgery in bleeding peptic ulcers. Emergency endoscopy must therefore be performed as early as possible.


References

  1. Block, Berthold; Schachschal, Guido; Schmidt, Hartmut H. (2004-01-01). Endoscopy of the Upper GI Tract: A Training Manual. Thieme. ISBN 9783131367310.

  2. Hadzibulic E, Govedarica S.  Significance of Forrest classification, Rockall’s and Blatchford’s risk scoring system in prediction of rebleeding in peptic ulcer disease.   Acta Medica Medianae 2007,Vol.46


  3. Heldwein W; Schreiner J; Pedrazzoli J; Lehnert P (Nov 21, 1989). "Is the Forrest classification a useful tool for planning endoscopic therapy of bleeding peptic ulcers?". Endoscopy. 21 (6): 258–62.  PMID 2693077

  4. Laine L, Peterson WL.  Bleeding peptic ulcer.  N Engl J Med. 1994 Sep 15;331(11):717-27.   https://www.ncbi.nlm.nih.gov/pubmed/8058080

  5. Forrest, JA.; Finlayson, ND.; Shearman, DJ. (Aug 1974). "Endoscopy in gastrointestinal bleeding". Lancet. 2 (7877): 394–7.  PMID  4136718.



Gastroenterology and related calculators


Gastrointestinal Diseases- an overview

Calculators / Tools

ABIC score – Stratification of risk of death in alcoholic hepatitis (AH)
Alcoholic Hepatitis Histological Score (AHHS)- Prognostic Stratification of Alcoholic Hepatitis
Child-Turcotte-Pugh Score -chronic liver disease - used to assess the prognosis of chronic liver disease, mainly cirrhosis. Although it was originally used to predict mortality during surgery, it is now used to determine the prognosis, as well as the required strength of treatment and the necessity of liver transplantation.
Crohn's Disease Activity Index (CDAI)- The CDAI is an important research tool for quantifying symptoms as well as determining the impact of drug therapy on overall symptoms.
Forrest classification - Risk stratification of upper gastrointestinal hemorrhage -UGIB
Glasgow alcoholic hepatitis score (GAHS) predicts survival from alcoholic hepatitis with respect to individual Glasgow alcoholic hepatitis score (GAHS) values
Glasgow-Blatchford bleeding score (GBS)- Screening tool for acute upper gastrointestinal bleeding (UGIB)  
Harvey-Bradshaw Index - useful tool for assessing the degree of illness (activity) in patient's with Crohn's disease
Irritable Bowel Syndrome (IBS) treatment options
Lille Model Scoring in Severe Alcoholic Hepatitis - helps to identify patients 'early' with severe alcoholic hepatitis that are likely to respond to steroid therapy or who will require alternative treatment options.
Mayo Scoring System for Assessment of Ulcerative Colitis
MELD Score (Model For End-Stage Liver Disease) - useful tool in predicting the probability of death from liver disease and how urgently an individual needs a liver transplant in the next three months.
MELD-Na Score (Model For End-Stage Liver Disease) -United Network for Organ Sharing proposed that MELD-Na score (an extension of MELD) may better rank candidates based on their risk of pre-transplant mortality and is projected to save 50-60 lives total per year.
Modified Maddrey's discriminant function (mDF) - (Score) is a predictive statistical model useful for evaluating the severity and prognosis in alcoholic hepatitis
Ransons Criteria mortality risk for acute pancreatitis- clinical prediction rule for predicting the prognosis and mortality risk of acute pancreatitis.
Rockall score for the evaluation of upper gastrointestinal bleeding - based on clinical criteria including age, shock and presence of other comorbidities. The scoring system helps evaluate patients at risk of re-bleeding or death following acute upper gastrointestinal bleeding
Rome iii criteria for IBS
Rome IV diagnostic criteria -Irritable Bowel Syndrome
Stool Osmotic Gap- Secretory vs Osmotic diarrhea
gastroenterology
Forrest classification – Risk stratification of UGIB

thpxl